Home | Procedures | TIPS
By Dr.Venkatesh
Radiologist
Published on 21 October 2022

Article Context

  1. Overview
  2. Procedure
  3. Benefits and risks
  4. Care at Medicover
  5. Frequently Asked Questions

Overview

Transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive procedure that involves the creation of a low-resistance channel between the hepatic vein and a portion of the portal vein within the liver. An interventional radiologist uses radiological and angiographic techniques to perform the procedure. An expandable metal stent is placed across the channel to keep it open, allowing blood to bypass the liver and return to the systemic circulation.

The purpose of TIPS is to surgically bypass without an open surgery, reroute blood flow in the liver, and reduce abnormally high blood pressure in the veins of the stomach, esophagus, bowel, and liver.

Indications

Portal hypertension: TIPS is typically performed on patients who have elevated pressure in the portal vein system, a condition known as portal hypertension. TIPS is especially beneficial in the following complications of portal hypertension:

  • Variceal bleeding: Variceal bleeding can occur in veins that normally drain the gastrointestinal organs such as the stomach, esophagus, or intestines into the liver. TIPS is used when standard treatment fails to control acute variceal bleeding, to prevent recurrent episodes of variceal bleeding, or to treat variceal bleeding while awaiting a liver transplant.
  • Portal gastropathy: Engorgement of the veins in the stomach wall can also cause severe bleeding.
  • Severe ascites or hydrothorax: Accumulation of a serous fluid in the abdomen or in the chest.

Budd–Chiari syndrome: It is an extremely rare condition caused by a blockage of the hepatic veins that drain the liver. If there is a classic triad of abdominal pain, ascites, and liver enlargement, the syndrome is suspected.

Procedure

Before the Procedure

  • Patients should have blood tests such as serum electrolytes, a complete blood count, kidney function tests, an electrocardiogram (EKG), and a chest X-ray.
  • Pre-procedural evaluation also includes tests to assess liver function and to determine the severity of liver damage. A thorough physical examination is required in these patients to detect the presence of other complications such as hepatic encephalopathy and ascites.
  • Inform the doctor about all the medications, including herbal supplements, any allergies, particularly to local anesthetics, general anesthesia, or contrast materials. Before your procedure, your doctor may advise you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDS), or blood thinners.
  • If a woman is pregnant, she should notify her doctor. Doctors will not perform any tests during pregnancy to avoid exposing the fetus to radiation. If an x-ray is required, the doctor will take steps to limit the baby's exposure to radiation.
  • You should fast after midnight, the night before your procedure.

During the Procedure

  • You will be positioned on your back and connected to monitors that will track your blood pressure, pulse, and heart rate. The nurses will prepare you for the TIPS procedure by inserting an intravenous or IV line.
  • The catheter placement site will be shaved, sterilized, and draped with a surgical drape.
  • The upper part of the right collarbone will be anesthetized before a small cut in the skin is made at the site. The ultrasound will be used to locate the internal jugular vein and guide the catheter into the hepatic vein.
  • Pressure is measured within the right side of the heart and hepatic vein to confirm the diagnosis and severity of portal hypertension.
  • A contrast agent will be injected into the hepatic vein to aid in the placement of the TIPS stent and the identification of the portal venous system. A TIPS needle is then used to gain access from the hepatic vein to the portal system.
  • The stent will be inserted through the portal vein and into the hepatic vein using fluoroscopy. The balloon is inflated after the stent has been properly placed, expanding the stent into place.
  • The stent opens a channel between the two veins. Blood flows freely into the hepatic vein via the shunt. This reduces the high pressure in the portal vein.
  • Your portal vein pressure is checked at the end of the procedure to ensure that it has decreased.
  • The skin will then be closed with a bandage.

After the Procedure

  • Blood pressure and pulse will be closely monitored for several hours following the procedure.
  • After the procedure, you will be unable to eat or drink for several hours.
  • The catheter in your neck could be there for a day or longer.
  • One or more ultrasound tests may be performed to assess how well the shunt is working.
  • You have to stay back in the hospital overnight for observation.
  • Repeated ultrasound scans are recommended in the first few weeks following the procedure to ensure that the stent is in proper position and working normally.

Benefits

  • TIPS is intended to produce the same physiological results as a surgical shunt while avoiding the risks associated with open surgery.
  • TIPS is a minimally invasive procedure that requires less recovery time than surgery.
  • As the abdomen was not disturbed, there will be no scar tissue formed in the abdomen, so TIPS will have less effect on future liver transplantation surgery than open surgical bypass.
  • TIPS is a stent present entirely in the diseased liver and keeps the shunt open and is removed along with the diseased liver during a transplant.
  • There is no need for a surgical incision—only a small nick in the skin that does not require stitches.

Risks

The 2 major complications due to TIPS procedure:

  • Hepatic encephalopathy: This is a condition in which altered mental status is caused by toxic products from the intestines (ammonia). The liver normally removes this ammonia from the blood. TIPS allows toxin-containing blood with ammonia to bypass the liver when performed. This may have an effect on your brain, causing confusion or even a comma.
  • Heart failure: This is due to an increase in the amount of blood returning to your heart through TIPS. The heart may not be able to return blood to the body quickly, resulting in heart failure.

Care at Medicover

Medicover Hospitals have the best team of liver specialists. All the doctors are highly trained, knowledgeable and have extensive experience in their field. Our interventional radiologists and team with their expertise and skills, handle transjugular intrahepatic portosystemic shunt surgeries with impeccable precision. Our surgeons are well-versed with and practice the most advanced techniques to help deliver the best clinical outcomes. The team is also well-equipped with advanced technology, high end equipment to achieve the best and most precise results. We provide the highest level of excellence and precision through quality diagnosis and treatment.

Frequently Asked Questions:

TIPS (transjugular intrahepatic portosystemic shunt) is a minimally invasive procedure used to treat portal vein hypertension and other advanced liver disease complications.

TIPS can be performed under general anesthesia to prevent you from feeling any pain that you may experience during the procedure.

Portal hypertension is a pathological increase in portal venous pressure caused primarily by chronic end-stage liver disease.

A diet with low protein and salt may be suggested.

References