Transjugular Intrahepatic Portosystemic Shunt (TIPS)
How does liver disease cause bleeding?
Liver disease can increase the pressure within the veins in the liver. This, in turn, raises the pressure in the blood from your stomach, intestines, and spleen, which flows into the liver. As a result, the veins in the stomach and esophagus (tube that passes food from the mouth to the stomach) become distended or enlarged (called varices). These can burst and cause life-threatening bleeding.
What is a transjugular intrahepatic portosystemic shunt (TIPS)?
A TIPS is a decompression channel, a "bypass" that is created between the high and low pressure veins in the liver. High-pressure blood entering the liver can now flow through the TIPS and the pressure is reduced throughout the distended and bleeding veins.
The TIPS procedure is performed in the interventional radiology department by the interventional radiology care team. Using an intravenous (IV) line inserted into a vein in your neck, the provider will thread a small hollow tube (the catheter) into a low pressure vein in the liver and create the connection with the high pressure feeding veins in the liver. You will receive local anesthesia in the area where the catheter is inserted into your neck. You will also receive a sedative medication in an IV to make you relax and not be aware of the procedure. In some instances, general anesthesia is used.
The TIPS is a "stent" that is made of a metal, spring-like piece that is covered in a fabric to create a tube that keeps the vein bypass open.
How does my provider know if I need a TIPS?
A TIPS is most commonly created when the bleeding veins (varices) can no longer be adequately controlled by medications or endoscopy treatments.
What happens during the TIPS procedure?
This procedure is considered safer than surgery because it does not require an incision and is performed under local anesthesia. A TIPS procedure generally takes two hours from start to finish. During the procedure:
- The provider inserts a small, hollow tube (catheter) through your skin into your jugular vein in your neck. On the end of the catheter is a tiny balloon and a metal mesh tube (stent).
- While taking X-rays, your provider guides the catheter into a vein in your liver.
- A contrast solution (dye) is then injected into the vein so that it can be seen more clearly.
- The balloon is inflated to place the stent. You may experience some discomfort at this time.
- The provider uses the stent to connect your portal vein to one of the veins in your liver (hepatic vein).
- Once complete, the provider will measure the pressure in your portal vein to make sure it has gone down. A decrease in pressure in your portal vein means the procedure was successful.
- The balloon on the catheter is deflated and the catheter is removed through the same vein it was inserted.
- After the procedure, a small bandage is placed over the neck area. There are usually no stitches.
Keep in mind that each case is different. Be sure to speak with your provider about the specifics of your procedure and what you might expect before, during, and after your TIPS procedure.
Is the procedure painful?
Your treatment team will keep you comfortable. They can anticipate what parts of the procedure can be painful and increase the amount of sedation during that time. You will be monitored with blood pressure, heart and breathing monitors.
What are the possible complications?
The TIPS procedure is complex, yet in most cases it can be performed with minimal complications. Your care team will alert you to any unusual potential complications for your particular case.
Both TIPS and liver bypass surgery can lead to mild confusion and lethargy (sleepiness). This is caused by encephalopathy (altered brain function), which can develop because some liver blood is diverted through the TIPS in order to lower the pressure in the veins. This can allow toxins that are normally cleared by the liver to bypass the liver's "filters" and build up in the blood stream. This can usually be treated with a medication that helps clear the toxins, but in rare cases may require reversal of the shunt.
Other possible complications include bruising, bleeding, infection and allergic reaction or kidney damage due to the contrast dye used. Very rare complications include bleeding in the abdomen, infection of the stent, injury to the main liver artery and blockage of the stent. Your care team will review the potential side effects, the risks versus benefits and symptoms to report to your provider.
Will I need to have any follow-up visits?
A TIPS is excellent at preventing repeat bleeding as long as it remains open. At present, TIPS can develop narrowing, which can lead to recurrent bleeding. The narrowing may occur without symptoms. For this reason, you will require regular outpatient follow-up at approximately 3 to 9 month intervals to ensure that the TIPS remains fully functional. The follow-up intervals become less frequent after the first year or two. Any narrowing within the TIPS is easily treated with an outpatient procedure.
How to prepare for TIPS
You may be asked to have lab work drawn, EKG and a chest x-ray completed prior to having a TIPS procedure. Ask your provider if it is safe to take all of your medications prior to the procedure. You will be instructed to not eat or drink anything prior to the procedure, usually starting at midnight the night before.
In general, patients who are having TIPS placement will remain in the hospital overnight and will be discharged the day after the procedure. If you require the procedure on an emergency basis, your hospital stay may vary.
National Institute of Health. MedlinePlus. Transjugular intrahepatic portosystemic shunt (TIPS). 2015. Retrieved from https://www.nlm.nih.gov/medlineplus/ency/article/007210.htm
National Library of Medicine. (2017). Transjugular intrahepatic portosystemic shunt (TIPS). Retrieved from https://medlineplus.gov/ency/article/007210.htm
RadiologyInfo. Transjugular intrahepatic portosystemic shunt (TIPS). 2015. Retrieved from http://www.radiologyinfo.org/en/info.cfm?pg=tips