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Transjugular intrahepatic portosystemic shunt (TIPS)

Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure to create new


connections between two blood vessels in your liver. You may need this procedure if
you have severe liver problems.
Description
This is not a surgical procedure. It is done by a radiologist using x-ray. A radiologist
is a doctor who uses imaging techniques to diagnose and treat diseases.
You will be asked to lie on your back. You will be connected to monitors that will
check your heart rate and blood pressure.
You will probably receive local anesthesia and medicine to relax you. This will make
you pain-free and sleepy. Or, you may have general anesthesia (asleep and painfree).
Your radiologist will insert a catheter (a flexible tube) through your skin into a vein
in your neck.
On the end of the catheter is a balloon and a metal mesh stent (tube).
Using x-ray equipment, your radiologist will guide the catheter into a vein in your
liver.
The balloon will be blown up to place the stent. You may feel a little pain when this
happens.
Your radiologist will use the stent to connect your portal vein to one of your hepatic
veins.
At the end of the procedure, your portal vein pressure will be measured to make
sure it has gone down.
After the procedure, a small bandage is placed over the neck area. There are usually
no stitches.
The procedure takes about 60 - 90 minutes to complete.
This new pathway will allow blood to flow better. It will ease pressure on the veins of
your stomach, esophagus, intestines, and liver.
Why the Procedure is Performed
Normally, blood coming from your esophagus, stomach, and intestines first flows
through the liver. When your liver has a lot of damage and there are blockages,
blood cannot flow through it very easily. This is called portal hypertension (increased
pressure and backup of the portal vein).

Common causes of portal hypertension are:


Alcohol abuse
Blood clots in a vein that flows from the liver to the heart
Too much iron in the liver (hemochromatosis)
Viral hepatitis (hepatitis B or hepatitis C)
When portal hypertension occurs, you may have:
Bleeding from veins of the stomach, esophagus, or intestines (variceal bleeding)
Buildup of fluid in the belly (ascites)
Buildup of fluid in the chest (hydrothorax)
This procedure allows your blood to flow better in your liver, stomach, esophagus,
and intestines, and then back to your heart.
Risks
Possible risks with this procedure are:
Damage to blood vessels
Fever
Hepatic encephalopathy (a disorder that affects concentration, mental function, and
memory, and may lead to coma)
Infection, bruising, or bleeding
Reactions to medicines or the contrast dye
Stiffness, bruising, or soreness in the neck
Rare risks are:
Bleeding in the belly
Blockage in the stent
Cutting of blood vessels in the liver
Heart problems or abnormal heart rhythms
Infection of the stent
Before the Procedure

Your doctor may ask you to have these tests:


Blood tests (complete blood count, electrolytes, and kidney tests)
Chest x-ray or EKG
Always tell your doctor or nurse:
If you are or could be pregnant
Any drugs you are taking, even drugs, supplements, or herbs you bought without a
prescription (your doctor may ask you to stop taking blood thinners like aspirin,
heparin, or warfarin a few days before the procedure)
On the day of your procedure:
Do not eat or drink anything after midnight the night before the procedure.
Ask your doctor which medications you should still take on the day of the procedure.
Take these drugs with a small sip of water.
Take a shower the night before or the morning of the procedure.
Your doctor or nurse will tell you when to arrive at the hospital.
You should plan to stay overnight at the hospital.
After the Procedure
After the procedure, you will recover in your hospital room. You will be monitored for
bleeding. You will have to keep your head raised.
There is usually no pain after the procedure.
You will be able to go home when you feel better. This may be the day after the
procedure.
Many people get back to their everyday activities in 7 to 10 days.
Your doctor will probably do an ultrasound after the procedure to make sure the
stent is working correctly.
You will be asked to have a repeat ultrasound in a few weeks to make sure that the
TIPS procedure is working.
Outlook (Prognosis)
Your radiologist can tell you right away how well the procedure worked. Most
patients recover well.

TIPS works in about 80% - 90% of portal hypertension cases.


The procedure is much safer than surgery and does not involve any cutting or
stitches.