Transjugular Intrahepatic Portosystemic Shunt

A transjugular intrahepatic portosystemic shunt (TIPS) is a small, tubular metal device, commonly called a stent, that is placed in veins in the middle of the liver to permit bloodflow to bypass the liver.

In a TIPS procedure, interventional radiologists use X-ray guidance to make a tunnel through the liver and connect the portal vein (the vein that carries blood from the digestive organs to the liver) to one of the hepatic veins (three veins that carry blood away from the liver back to the heart). A stent is then placed in this tunnel to keep the pathway open.

Patients who typically need a TIPS placement have portal hypertension, or increased pressure in the portal vein. This pressure causes blood to flow backward from the liver into the veins of the spleen, stomach, lower esophagus and intestines, causing enlarged vessels, bleeding and the accumulation of fluid in the chest or abdomen.

What Are Some Common Uses of the Procedure?
A TIPS procedure is used to treat the complications of portal hypertension, including:

  • Variceal bleeding—Bleeding from any of the veins that normally drain the stomach, esophagus or intestines into the liver.
  • Portal gastropathy—An over-filling of the veins in the wall of the stomach, which can cause severe bleeding.
  • Severe ascite—The accumulation of fluid in the abdomen and/or chest.
  • Budd-Chiari syndrome—A blockage in one or more veins that carry blood from the liver back to the heart.

What Are the Benefits and Risks?

Benefits

  • A TIPS is designed to produce the same physiological results as a surgical shunt or bypass without the risks that accompany open surgery.
  • TIPS is a minimally invasive procedure that typically has a shorter recovery time than surgery.
  • Your TIPS should have less of an adverse effect than open surgical bypass on future liver transplantation surgery because the abdomen has not been entered and thus there is no scar tissue formed in the abdomen.
  • The TIPS is contained entirely inside the diseased liver and is removed with it during a transplant operation.
  • Studies have shown that this procedure is successful in reducing variceal bleeding in more than 90% of patients.
  • No surgical incision is needed—only a small nick in the skin that does not have to be stitched closed.

Risks

  • Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
  • There is a very slight risk of an allergic reaction to the contrast material used for venograms. Also, kidney failure (temporary or permanent) due to contrast material use is a concern, particularly in patients with poor kidney function.
  • Any procedure that involves placement of a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection.

What to Expect
Prior to appointments, Gwinnett Medical Center patients are asked to come in for routine lab work. It is preferred that patients have their lab work performed at Gwinnett Medical Center so the radiology nurses have access to the results. Our radiology nurses call each patient shortly after the procedure is scheduled to obtain a health history and provide instructions.

For most interventional radiology exams, patients need to arrive in admissions two hours before their scheduled procedure time on the day of the exam. Patients will check in at admissions before being taken to the Imaging Nursing Unit, where an interventional radiologist will come to talk with the patient before the procedure. The patient will then be prepped for the exam and taken to the Interventional Radiology Suite for the procedure. Following the procedure, the patient will return to the Imaging Nursing Unit for recovery. The recovery time varies based on the procedure. After the patient is then discharged, he or she will receive a follow-up call the next day.

Call 678-312-3444 to schedule an appointment at one of our convenient locations in Lawrenceville, Duluth or Hamilton Mill.