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Transjugular intrahepatic portosystemic shunt (TIPS)

Alternative Names

TIPS; Percutaneous shunting

Definition

Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure to treat complications of severe liver disease by diverting blood away from the blood vessels in the liver.

Description

The procedure is typically performed by radiologists. Many patients receive a local pain-killing medicine (anesthesia) to numb a small area of the skin and a sedative to relax them (conscious sedation), as well as pain medications. In certain cases, general anesthesia (where the patient is asleep) may be used.

A needle is placed in the jugular vein in the right side of the neck to make a small hole. Needles and long, thin tubes called catheters can then be placed through the neck into veins in the liver.

A needle is inserted to make a connection between a branch of the vein that carries blood to the liver (portal vein) and another vein in the liver. This channel is then expanded. A tube called a stent is inserted to allow blood to flow more easily through the liver. This tube is left in place.

Why the Procedure is Performed

Complications of severe liver disease can include bleeding from the esophagus or stomach, and build-up of fluid in the abdomen, which are caused by high pressure in the blood vessels (portal veins) of the liver.

The purpose of this procedure is to send blood away from these veins. This relieves the pressure of blood flowing through the diseased liver and can help stop bleeding and fluid back-up.

This procedure is used if you have not responded to less invasive treatments (such as salt restriction in the diet, medications called diuretics to remove fluid, and fluid drainage). This may include bleeding from esophageal varices.

Risks

At the time of the procedure, the risks include:

• A reaction to the anesthesia
• Bleeding into the abdomen or esophagus
• Cardiac arrhythmia

Encephalopathy is a common problem in patients with severe liver disease. After the TIPS has been inserted, the encephalopathy often gets worse. A patient who has had encephalopathy may not be a good candidate for TIPS.

Blockage of the TIPS occurs in most patients within the first year after the TIPS is placed. This blockage may lead to bleeding or fluid build-up. If this occurs, the TIPS can be expanded, or a new TIPS may be created.

Death has been reported after TIPS placement. The risk is from complications at the time of the procedure. In addition, deaths have been reported due to liver failure that gets worse in the days and weeks after TIPS placement. Patients with more advanced liver disease are at greater risk for worsening liver failure after TIPS placement.

Outlook (Prognosis)

You will be monitored after the procedure, as you wake up from the anesthesia. An ultrasound is usually done the morning after the procedure to show that the TIPS is open and functioning well.

Recovery

The main goal during the recovery period is to watch for signs of complications. Anesthesia helps prevent pain at the time of the procedure, and there is often little, if any, discomfort after the procedure.

References

LaBerge JM. Transjugular intrahepatic portosystemic shunt--role in treating intractable variceal bleeding, ascites, and hepatic hydrothorax. Clin Liver Dis. 2006;10:583-598.

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