Portal hypertension and pancreatic cancer, TIPSS as a bridge to a safe resection

Background: Pancreaticoduodenectomy (PD) is a complex operation associated with high morbidity, especially in the setting of hepatic fibrosis/cirrhoses and portal hypertension. Portal hypertension is a near certain contraindication for PD and may preclude patients with resectable malignancy from a curative operation. Transjugular intrahepatic portosystemic shunt (TIPSS) is an artificial path between the portal vein and suprahepatic veins for decreasing the portal pressure, defined as a hepatic venous pressure gradient > 5mmHg. TIPS can be used as a bridge to facilitate safe performance of PD. We reviewed our experience over the past decade at a single institution.