Transjugular intrahepatic Porto-systemic shunt (TIPS):
What is a TIPS procedure?
TIPS is a radiological procedure in which a shunt is placed in the middle of the liver with the intention of rerouting the blood flow. It is a procedure that is done on patients with portal hypertension, which is a condition characterized by increased pressure in the portal vein. The increase in pressure is caused by a blockage of the blood flowing throughout the liver. Having portal hypertension causes blood flow to be forced backward, causing veins to enlarge and varices to develop across the esophagus and stomach as a result of the pressure in the portal vein. This backup of pressure can also cause the spleen to become enlarged. The TIPS procedure is not a surgical procedure. It is performed by a radiologist and is used to manage the complications of portal hypertension.
What can expect before this procedure?
Before the TIPS procedure is done, your physician will perform a variety of tests on you in order to determine the severity of your portal hypertension. These may include:
- Evaluation of your medical history
- Galactose liver function test
- A physical examination
- Ultrasound or angiogram
- Blood tests
- Endoscopy
Prior to this procedure, you will be instructed to refrain from eating anything after midnight the night before the exam. You will only be allowed to drink clear liquids. You will be given an intravenous line (IV) before the physician begins. The procedure should last approximately 1 to 3 hours and you should plan to stay in the hospital or clinic 2 to 3 days after the procedure.
What can I expect during this procedure?
You will be sedated during the entire procedure. Once you are comfortably asleep, the radiologist will make sure your neck is washed with an iodine solution to sterilize it and you will be covered with sterile drapes to prevent infection. The radiologist will then pass a needle through the skin of your neck and into your right internal jugular vein. This needle is then replaced with a catheter system that extends from the jugular vein to the hepatic veins, which are the primary veins in your liver.
The catheter system is used to pass a long needle through the liver tissue between your hepatic vein and your portal vein. Once the needle has entered your portal vein, a guide wire is placed into your main portal vein, the needle is removed, and the guide wire is used to then pass a balloon catheter into your main portal vein. The balloon is inflated and this enlarges the track between the two veins.
The balloon catheter is then removed and a metal stent is placed across the track between the two veins. This stent is enlarged by the balloon catheter until it widens the track to the appropriate size. The radiologist determines the appropriate size by measuring the pressures across the shunt and by viewing the portal vein with angiographic images. Once the pressures and angiographic picture are desirable to the physician, the catheters are removed and general pressure is applied to the site of catheter entry in your neck until there is no further bleeding. You will then be transferred to a recovery location for further observation.
What can I expect after this procedure?
After the procedure is completed, you will be observed closely by your physician and nurses. Your physician will conduct an ultrasound to determine if the procedure was effective. If the shunt appears to be functioning properly, you will be discharged. Your progress will again be evaluated after approximately two weeks. Six weeks after the procedure, three months, and again at six months, your physician will conduct ultrasounds to observe the progress. You will continue to meet periodically with your physician for the first year in order to ensure the shunt is still working properly. If you have any questions about your recovery, please contact a nurse clinician as soon as possible.
Related websites and resources:
- Functions of the liver
- What is portal hypertension?
- The role of Transjugular Intrahepatic Portosystemic Shunt in the Management of Portal Hypertension (AASLD document)
- More patient resources
| University of Missouri Health Care | This information is not intended to replace the advice of a doctor. |
