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    Finally, with TIPS there is the risk of worsening encephalopathy viagra samples free online , although the symptoms are mild and controlled with medications [21]. This allows a lower rate of encephalopathy (<10%) compared to the other shunts [44]. The distal splenorenal shunt (DSRS) is the principal selective shunt, as it controls bleeding by selectively decompressing gastroesophageal varices through the short gastric veins and the splenic vein to the left renal vein, while maintaining portal flow to the cirrhotic liver [53]. Although TIPS viagra samples free online is used much more frequently compared to the surgical procedures, this does not necessarily mean that it is better. Overall, it appears to be one of the more popular ones, as it has a low risk of operative morbidity, less shunt dysfunction and good long-term survival [45].

    The surgical options currently used for variceal bleeding are either shunt or nonshunt procedures, with shunt procedures further divided into selective and non-selective, as can be seen in Table 2 [42]. A large, multicenter trial of TIPS versus DSRS found similar rates of encephalopathy, rebleeding and mortality in patients with Child‟s A and B cirrhosis who had failed endoscopic or pharmacologic therapy, with a higher rate of shunt dysfunction in the TIPS group [26].

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