What is a transjugular intrahepatic portosystemic shunt? (2023)

Transjugular intrahepatic portosystemic shunt, also known as TIPS, is a procedure in which a stent, a small coil of wire mesh, is placed into a hepatic vein to create a conduit, or shunt, that bypasses the liver. The goal of TIPS is to reduce congestion in the blood.Liverand 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 through a small access point in the neck and into the liver.

What is TIPS?

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

A TIPS procedure is performed under image guidance. The dye is injected into different locations to allow the radiologist to see the veins effectively.

The procedure consists of several steps:

• A small incision is made in the neck to accessDrosselvene. A tube (catheter) is inserted into the vein and guided downward with the help of the hepatic veins.bone scanimaging The catheter contains a small balloon and a stent that is left in place 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 little saline to expand the metal stent (which forms the shunt).
• The balloon is then deflated.
• Venous pressure is measured throughout the procedure to ensure that the shunt is effective.
• The radiologist treats any areas of bleeding.
• The catheter is removed and the stent is left to create the shunt.
• A small bandage is placed over the small incision for the catheter.

contraindications

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

• Elevated right or left heart pressure
• Heart failure or severe lack of heart valves
• deteriorates rapidlyliver failure
• Severe or uncontrolled liver disease affecting brain function (hepatic encephalopathy)
• sin controlSepticemiaor systemic infection
• Unresolved blocked duct that carries bile from the liver through the gallbladder to the intestines (biliary obstruction)
• polycystic liver disease
• Liver cancer(liver cancer or metastatic liver cancer)
• Severe, uncorrectable bleeding or clotting disorders (coagulopathy)

Possible risks

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

• damage to blood vessels
• Hepatic encephalopathy
• Infection, bruising, or bleeding
• Allergic reactions to medications or dye used for the procedure.
• neck stiffness, bruising, or pain
• bleeding in the abdomen
• TIPS stent blocking
• 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 could have that would indicate a need for the TIPS process:

• Increased pressure in the portal veins that connect the intestines to the liver (portal hypertensionn) caused by scarring of the liver from alcohol abuse (hepatic cirrhosis), blood clots in the vein leading from the liver to the heart, increased iron levels in the liver (hemochromatosis), yHepatitis B or C
• Uncontrollable bleeding from the veins of the esophagus and stomach (variceal bleeding)
• Recurrent excessive variceal bleeding (variceal bleeding) despite therapy
• Excessive accumulation of fluid in the tissues between the abdomen and the organs of 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 result from severe liver disease. There are other ways to manage symptoms before opting for this option. Your doctor may decide to try this approach to prevent excessive bleeding.

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

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

How to prepare

ort

Patients typically undergo a TIPS procedure at an interventional radiology hospital by a radiologist who uses imaging to diagnose and treat disease. Upon entering the procedure area, the team asks the patient to climb onto the bed, lie on their back, and uncover their neck for the procedure.

what to wear

It is important that you come in comfortable clothing on the day of the procedure. Comfortable pants and shoes are a good choice, and possibly a sweater or jacket, as it can get cold in the hospital. Patients are asked to change into a treatment gown before entering the treatment room.

eat and drink

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

medicine

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

What Brig

It is important to bring photo identification and insurance cards with you on the day of the procedure. To spend the night in the hospital, a travel bag with any utensils (for example, glasses or mobile phone charger) must be available.

What to expect the day of the procedure

Before the procedure

In the pre-operative area on the day of the procedure, a nurse will assess your vital signs, weight, pregnancy status (if applicable), and blood glucose level (if applicable). Patients remove their clothing and jewelry and put on a surgical gown that allows the radiologist to easily reach the surgical site.

during the procedure

The procedure usually takes between 60 and 90 minutes. Numbing medicines are given to the neck where the catheter is inserted into the jugular vein. Medications are given to help the patient relax while awake for the procedure. Some patients are completely euthanizedgeneral anesthesia(This will be determined by the anesthesia team prior to the procedure.)

When the radiologist inserts the stent, there may be pressure or pain in the abdomen. This is to be expected and normal during this procedure.

After the procedure

After the procedure, the radiologist uses ultrasound to check if the stent is fully open and working properly. TIPS is considered successful in approximately 80% to 90% of patients with portal hypertension.

recreation

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

heal

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

long term care

About seven to 14 days after the procedure, the radiologist will use an ultrasound to confirm that the shunt is working and open to allow blood flow. 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, for example, can be used periodically to check that the stent is fully open and flowing freely.

resume

The TIPS procedure can help reduce high blood pressure in the portal veins, which filter blood from the intestines through the liver, and its complications, particularly bleeding when those veins rupture due to increased pressure. It is typically used to help with liver diseases 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 arising from portal hypertension in patients with severe liver disease. All procedures have risks, but this procedure has a lower risk compared to liver surgery. Although TIPS is not a cure for liver disease, it is a step in the treatment process to reduce symptoms and improve quality of life for patients with liver disease.