What is a transjugular intrahepatic portosystemic shunt? (2023)

The transjugular intrahepatic portosystemic shunt, also known as TIPS, is a procedure in which a stent, a small coil of wire mesh, is placed in a liver vein to form a channel, or shunt, that bypasses the liver. The purpose of TIPS is to reduce the pooling of blood in theliverand other complications of severe liver disease, such ashepatitisand cirrhosis.

It is a minimally invasive (non-surgical) procedure that allows an interventional radiologist to place an image-guided stent into the liver through a small access point in the neck.

What is TIPS?

TIPS is a connection created between a vein in the liver (hepatic vein) and a branch of the portal vein to reduce pressure in theportal vein. A portal vein carries blood to the liver from the spleen, stomach, pancreas, and intestines.

A TIPS procedure is performed under image guidance. Dye is injected at different points to allow the radiologist to see the veins effectively.

There are several steps to the procedure:

• A small incision is made in the neck to access theI saw jugular. A small tube (catheter) is inserted into the vein and guided into the veins of the liver usingbone scanimaging The catheter contains a small balloon and stent that will be left to create the shunt.
• A needle is used to create a passage between the hepatic vein and a branch of the portal vein.
• The catheter balloon is then inflated with a small amount of saline to expand the metal stent (which creates the shunt).
• The balloon is then deflated.
• Vein pressures are measured throughout the procedure to ensure the bypass is effective.
• The radiologist will treat any areas of bleeding.
• The catheter is withdrawn and the stent is left behind to create the shunt.
• A small bandage is placed over the small incision made for the catheter.

contraindications

There are some conditions that may make someone not a suitable candidate for TIPS, although this is not absolute and is up to the radiologist to decide. The following conditions can lead to complications after a TIPS procedure:

• Elevated right or left heart pressures
• Heart failure or severe heart valve deficiency
• rapid deteriorationliver failure
• Severe or uncontrolled liver disease affecting brain function (hepatic encephalopathy)
• sin controlsepticemiaor systemic infection
• Unrelieved blocked duct that carries bile from the liver to the intestines through the gallbladder (biliary obstruction)
• polycystic liver disease
• liver cancer(liver malignancy or metastatic liver cancer)
• Severe, uncorrectable bleeding or clotting disorders (coagulopathy)

potential risks

Every procedure carries a certain level of risk, and some are more likely than others. Potential TIPS risks include:

• Damage to blood vessels
• hepatic encephalopathy
• Infection, bruising, or bleeding
• Allergic reactions to medications or dyes used for the procedure.
• Neck stiffness, bruising, or pain
• belly bleeding
• TIPS Stent Lock
• Blood clots in the blood vessels of the liver
• heart problems orabnormal heart rhythms
• TIPS stent infection

Purpose of a TIPS procedure

There are several conditions that a person may have that indicate the need for the TIPS procedure:

• Increased pressure in the portal veins that connect the intestines to the liver (portal hypertensionn) created by scarring of the liver due to alcohol abuse (hepatical cirrhosis), blood clots in the vein leading from the liver to the heart, increased levels of iron in the liver (hemochromatosis), youhepatitis B or C
• Uncontrollable bleeding from veins throughout the esophagus and stomach (variceal bleeding)
• Recurrent excessive variceal bleeding (varicose bleeding) despite therapy
• Excessive accumulation of fluid in the tissues between the abdomen and organs in the abdominal cavity (ascites)
• Fluid in the chest cavity due to severe liver disease (hepatic hydrothorax)

A TIPS procedure is not the first line of treatment for many of these conditions that stem from severe liver disease. There are other options to treat the symptoms before following this option. Your doctor may decide to try this approach to prevent excessive bleeding.

One of the guidelines for deciding when to perform a TIPS procedure is persistent bleeding and severe rebleeding within five days after treatment. In this scenario, rebleeding should be treated with a TIPS procedure. If the procedure is successful, it is likely to reduce mortality and improve ascites control.

Tests such as blood tests and imaging (computed tomography (CT) or magnetic resonance imaging (MRI)) will be done before the procedure to visualize the patient's anatomy and assess the likelihood of a successful procedure. The blood test includes a complete blood count (complete blood count), liver function tests and a coagulation profile (clotting status).

How to prepare

location

Patients usually undergo a TIPS procedure in a hospital setting, in interventional radiology by a radiologist who uses imaging to diagnose and treat disease. Upon entering the procedure area, the team will ask the patient to move to the bed for the procedure, lying on his back exposing his neck.

what to wear

It is important to arrive on the day of the procedure in comfortable clothes. Comfortable pants and shoes are a good choice, and possibly a sweater or jacket because the hospital can get cold. Patients will be asked to put on a procedure gown before entering the procedure room.

Food and drink

Patients will be instructed not to eat or drink anything after midnight before the procedure. Certain medications can be taken with small sips of water, but nothing else should be consumed unless otherwise directed by your doctor.

medicines

Patients must provide a complete list of current medications and alert the physician of any medication changes or omissions on the day of the procedure. The physician will determine whether medications or supplements that may cause increased bleeding should be continued or discontinued, depending on each patient's medical situation.

what a fight

It is important to bring photo identification and insurance cards with you on the day of the procedure. An overnight bag with any belongings (such as eyeglasses or a phone charger) should be available for overnight hospital stays.

What to expect on the day of the procedure

Before the Procedure

In the preoperative area on the day of the procedure, a nurse will assess your vital signs, weight, pregnancy status (if applicable) and blood sugar levels (if applicable). Patients will remove clothing and jewelry and don a surgical gown that allows the radiologist easy access to the procedure site.

during the procedure

The procedure usually takes 60 to 90 minutes to complete. A numbing medication will be administered into the neck, where the catheter is inserted into the jugular vein. Medicines will be given to help the patient relax if he is awake for the procedure. Some patients will be put to sleep fully undergeneral anesthesia(this is determined by the anesthesia team prior to the procedure).

When the radiologist implants the stent, there may be some pressure or pain in the abdominal area. This is normal and expected during this procedure.

After the procedure

After the procedure, the radiologist will check that the stent is open and working properly with an ultrasound. TIPS is considered successful in about 80% to 90% of patients with portal hypertension.

Recovery

Patients undergoing TIPS must expect to wake up from general anesthesia in a recovery room and then be transferred to a hospital room for the night to control bleeding or other complications. The minimally invasive approach reduces the time it takes to recover from the procedure.

Healing

There is usually no pain after the procedure, although there may be some pain. A small bandage will cover the neck incision. It may take about seven to 10 days to return to normal activities.

long term care

The radiologist will use an ultrasound to confirm that the shunt is working and open to allow blood flow 7 to 14 days after the procedure. The shunt will continue to be monitored at three months, six months, and then every six to 12 months after the procedure.

More detailed images, such as a CT scan, can be used periodically to check that the stent is wide open and flowing freely.

Resume

The TIPS procedure can help reduce high blood pressure in the portal veins, which filter blood from the intestines to the liver, and its complications, especially bleeding when these veins burst due to increased pressure. It is typically used to help with liver conditions such as hepatitis and cirrhosis. It is not recommended for everyone with these conditions, and your doctor will help you determine if this procedure is right for you.

A Word from Verywell

The TIPS procedure can be successful in treating severe symptoms due to portal hypertension in patients with severe liver disease. All procedures carry risks, but this procedure reduced the risks compared to liver surgery. While TIPS is not a cure for liver disease, it is a step in the treatment process to reduce symptoms and improve the quality of life for patients with liver disease.