Transjugular intrahepatic portosystemic shunt (TIPS)

Description

This is not a surgical procedure. It is done by a radiologist using x-ray. A radiologist is a doctor who uses imaging techniques to diagnose and treat diseases.

You will be asked to lie on your back. You will be connected to monitors that will check your heart rate and blood pressure.

You will probably receive local anesthesia and medicine to relax you. This will make you pain-free and sleepy. Or, you may have general anesthesia (asleep and pain-free).

Your radiologist will insert a catheter (a flexible tube) through your skin into a vein in your neck.

• On the end of the catheter is a balloon and a metal mesh stent (tube).
• Using x-ray equipment, your radiologist will guide the catheter into a vein in your liver.
• The balloon will be blown up to place the stent. You may feel a little pain when this happens.
• Your radiologist will use the stent to connect your portal vein to one of your hepatic veins.
• At the end of the procedure, your portal vein pressure will be measured to make sure it has gone down.
• After the procedure, a small bandage is placed over the neck area. There are usually no stitches.
• The procedure takes about 60 - 90 minutes to complete.

This new pathway will allow blood to flow better. It will ease pressure on the veins of your stomach, esophagus, intestines, and liver.

Why the Procedure is Performed

Normally, blood coming from your esophagus, stomach, and intestines first flows through the liver. When your liver has a lot of damage and there are blockages, blood cannot flow through it very easily. This is called portal hypertension (increased pressure and backup of the portal vein). The veins can then break open (rupture), causing serious bleeding.

Common causes of portal hypertension are:

• Alcohol abuse
• Blood clots in a vein that flows from the liver to the heart
• Too much iron in the liver (hemochromatosis)
• Viral hepatitis (hepatitis B or hepatitis C)

When portal hypertension occurs, you may have:

• Bleeding from veins of the stomach, esophagus, or intestines (variceal bleeding)
• Buildup of fluid in the belly (ascites)
• Buildup of fluid in the chest (hydrothorax)

This procedure allows your blood to flow better in your liver, stomach, esophagus, and intestines, and then back to your heart.

Risks

Possible risks with this procedure are:

• Damage to blood vessels
• Fever
• Hepatic encephalopathy (a disorder that affects concentration, mental function, and memory, and may lead to coma)
• Infection, bruising, or bleeding
• Reactions to medicines or the contrast dye
• Stiffness, bruising, or soreness in the neck

Rare risks are:

• Bleeding in the belly
• Blockage in the stent
• Cutting of blood vessels in the liver
• Heart problems or abnormal heart rhythms
• Infection of the stent

Before the Procedure

Your doctor may ask you to have these tests:

• Blood tests (complete blood count, electrolytes, and kidney tests)
• Chest x-ray or EKG

Always tell your doctor or nurse:

• If you are or could be pregnant
• Any drugs you are taking, even drugs, supplements, or herbs you bought without a prescription (your doctor may ask you to stop taking blood thinners like aspirin, heparin, or warfarin a few days before the procedure)

On the day of your procedure:

• Do not eat or drink anything after midnight the night before the procedure.
• Ask your doctor which medications you should still take on the day of the procedure. Take these drugs with a small sip of water.
• Take a shower the night before or the morning of the procedure.
• Your doctor or nurse will tell you when to arrive at the hospital.
• You should plan to stay overnight at the hospital.

After the Procedure

After the procedure, you will recover in your hospital room. You will be monitored for bleeding. You will have to keep your head raised.

There is usually no pain after the procedure.

You will be able to go home when you feel better. This may be the day after the procedure.

Many people get back to their everyday activities in 7 to 10 days.

Your doctor will probably do an ultrasound after the procedure to make sure the stent is working correctly.

You will be asked to have a repeat ultrasound in a few weeks to make sure that the TIPS procedure is working.

Outlook (Prognosis)

Your radiologist can tell you right away how well the procedure worked. Most patients recover well.

TIPS works in about 80% - 90% of portal hypertension cases.

The procedure is much safer than surgery and does not involve any cutting or stitches.

Alternative Names

TIPS

References

Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 156.

Shah VH, Kamath PS. Portal hypertension and gastrointestinal bleeding. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier;2010: chap 90.

Sicklick JK, D'Angelica M, Fong Y. The liver. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 54.

Update Date: 1/14/2013

Updated by: A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zeive, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang. Previously reviewed by David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Joshua Kunin, MD, Consulting Colorectal Surgeon, Zichron Yaakov, Israel (7/25/2012).