TIPS (Transjugular Intrahepatic Portosystemic Shunt)
A healthy liver does many important jobs. It processes alcohol, food, and medicines. It makes digestive juices, helps with blood clotting, and helps your body fight infection. The portal vein is the large vessel that carries most of the blood from the intestine to the liver. Certain diseases or a blockage in the portal vein can cause blood pressure to rise in this vein. This often leads to fluid buildup in the belly (abdomen) and massive bleeding. The TIPS procedure helps ease the pressure in the portal vein. The procedure is done by a specially trained doctor called an interventional radiologist.
Although the TIPS procedure can lower portal pressure, it may make liver failure worse in people with severe liver disease. Encephalopathy can happen if too much blood bypasses the liver after a TIPS. Encephalopathy comes from toxins in the bloodstream that are normally filtered by the liver. The toxins build up in the brain. This can cause mental confusion, personality changes, memory loss, and sleepiness. Encephalopathy can be treated by having the stent in the bypass revised or completely blocking it off.
Getting ready for your procedure
Follow any instructions you are given to get ready. This includes any directions you’re given for not eating or drinking before the procedure.
Tell your healthcare provider if:
You are pregnant or think you may be pregnant
You are breastfeeding
You are allergic to X-ray dye (contrast medium) or other medicines
Tell your provider about all medicines you take. You may need to stop taking some or all of them before the test. This includes:
All prescription medicines
Over-the-counter medicines such as aspirin or ibuprofen
Herbs, vitamins, and other supplements
During your procedure
TIPS is a complex procedure. Your healthcare provider will explain it to you. Below is a summary of what will happen during the procedure.
You will be under general anesthesia or conscious sedation. You will have an IV (intravenous) line to give you fluid and medicines. You will also be given medicine through the IV to help you relax.
Local anesthesia is injected to numb the skin at the incision site. A very small cut (incision) is made on the right side of your neck. A needle with a guide wire attached is put through the incision into a vein.
X-ray dye is injected into the vein. This helps the vein show up clearly on X-ray images. Using these images as a guide, the radiologist moves the needle into another large vein in the liver (the hepatic vein).
The needle is pushed through the wall of the hepatic vein into the portal vein. A thin flexible tube (catheter) is threaded over the guide wire. A metal mesh cylinder (stent) is moved through the catheter and placed over the needle between the hepatic and portal veins. The stent creates a passageway (shunt) between the 2 veins. Blood flows freely through the shunt into the hepatic vein. This relieves the high pressure in the portal vein.
When the procedure is finished, the needle, wire, and catheter are taken out. The stent stays in place to hold the shunt open.
After your procedure
Your blood pressure and pulse will be watched closely for several hours after the procedure.
You will not be able to eat or drink for several hours after the procedure.
The catheter in your neck may stay in place for a day or longer.
You may have 1 or more ultrasound tests to check how well the shunt is working.
You will stay in the facility or hospital overnight for observation.
Risks and possible complications
All procedures have some risk. Possible risks of this procedure include:
Pain, bleeding or infection at the injection site
Allergic reactions to X-ray dye
Liver injury including internal liver bleeding
X-ray radiation exposure
Worsening of liver failure
Blockage of the stent with recurrence of symptoms
March 20, 2017
Boyer, TD. The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension: Update 2009. Hepatology (2010); 51(1); pp. 306-1-16, Transjugular Intrahepatic Portosystemic Shunt (TIPS). UpToDate., Up To Date. Transjugular Intrahepatic Portosystemic Shunts: Indications and Contraindications
Fraser, Marianne, MSN, RN,Qureshi, Javed, MD