What Is Transjugular Intrahepatic Portosystemic Shunting?
Transjugular intrahepatic portosystemic shunting (TIPS) is a procedure used to treat liver problems. TIPS is a minimally invasive procedure performed to connect two blood vessels in your liver.
People who have portal hypertension may need to have TIPS. The portal vein is a blood vessel that brings blood from your digestive system to your liver. Hypertension occurs when the pressure in the portal vein is too high due to cirrhosis of the liver or a blocked hepatic vein. Bleeding and the build-up of fluid in the abdominal area, called ascites, are symptoms of portal hypertension.
Medications can be used to control fluid accumulation in the abdomen. However, sometimes drugs do not effectively manage ascites. TIPS reduces fluid accumulation by re-routing blood around the liver.
TIPS is also used as a treatment for blocked hepatic veins. The hepatic veins, deliver blood from the liver to inferior vena cava and on to the heart. TIPS creates a tunnel between a hepatic vein and the portal veins to bypass the “backup” of blood flow in the portal vein.
Preparing for TIPS
A transjugular intrahepatic portosystemic shunt procedure is performed under sedation or general anesthesia. Under sedation, you will be awake but may be very sleepy. Under general anesthesia, you will be asleep. You may need to stop taking certain medications several days before your TIPS procedure, including:
- naproxen sodium
- blood-thinning medications
You will not be allowed to eat after midnight on the night before your procedure. You may or may not be allowed to drink water and clear liquids. Ask your doctor for specific instructions prior to your procedure.
Let your doctor know of any allergies you have to foods and medications. An iodine-based fluid called contrast dye may be used during TIPS to make your veins more visible. Some people experience allergic reactions to contrast dye.
You are more likely to show symptoms, including itching, flushing, and breathing difficulties, if you are allergic to iodine and shellfish.
The TIPS procedure is performed as you lie on your back. After you’re sedated, the doctor will use ultrasound equipment to find your jugular, which is just above the right side of your collarbone.
The doctor will insert a catheter—a thin, flexible, hollow tube—into the jugular vein. Then, the doctor will ease the catheter down to one of your hepatic veins, using X-ray imaging as a guide.
Once the hepatic vein is catheterized, the doctor will inject the contrast dye into the catheter. The dye helps identify the portal vein. Using a needle within the catheter, the doctor will open an area of the portal vein and place a stent inside. A stent is a small piece of mesh tubing that holds blood vessels open.
During a TIPS procedure, the stent makes a permanent opening between the portal and hepatic veins. The new opening between the veins causes blood to flow in a different pattern between the liver and heart. The newly formed pattern reduces portal pressure, which will stop bleeding and fluid retention in the abdomen.
The entire procedure is performed in 60 to 90 minutes.
After the shunt procedure, you will stay in the hospital overnight. You’ll need to keep your head elevated to reduce the risk of bleeding. Healthcare providers will closely monitor your heart rate, blood pressure, portal pressure, and breathing.
Before you go home, your doctor will look at the shunted veins on an ultrasound to make sure blood flows properly.
Recovery from TIPS continues with rest at home for a few days. Most patients are able to return to their normal activities within a week or so, according to the Radiological Society of North America (RSNA).
You may be scheduled for ultrasounds every three to six months. Follow-up appointments keep your doctor updated on your condition and the function of the TIPS.
TIPS effectively reduces portal hypertension in 80 to 90 percent of patients, according to the National Institutes of Health (NIH). Risks are rare, but can include:
- interruption of blood flow to the liver
- abnormal heartbeat
Let your medical care team know if you experience fever, swelling in your legs or abdomen, a stiff neck, breathing problems, or memory loss. These symptoms might indicate that the stent is no longer in place.