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Treatment / Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Transjugular Intrahepatic Portosystemic Shunt (or TIPS) is a procedure to place a small tube between the portal vein of the liver and the hepatic vein. It is used to treat portal hypertension, a condition that develops when cirrhosis of the liver causes a blockage in the portal vein.

What is Portal Hypertension?

The portal vein is the blood vessel responsible for transporting blood from your gastrointestinal tract, spleen, gallbladder and pancreas to your liver. The liver processes this nutrient-rich blood, extracting nutrients and filtering out toxins. Nearly 75 percent of the liver’s total blood flow comes through the portal vein, with the remainder flowing through the hepatic vein. The hepatic vein carries blood from the liver to the heart.

Portal hypertension occurs when the blood flow through the portal vein is blocked, usually by excessive scar tissue from cirrhosis. When this blockage occurs, the blood in the portal vein changes course, and begins to flow into smaller vessels across your esophagus and abdomen. These smaller vessels aren’t used to a large volume of blood, so they stretch to accommodate it, becoming enlarged veins known as varices. Because the veins are abnormally stretched, they become fragile and are prone to rupturing, causing abdominal or esophageal bleeding. In addition, when the blood is no longer flowing through the liver for filtering, other organs (such as the kidneys) are unable to effectively eliminate excess sodium, resulting in fluid retention in the abdomen (ascites).

What is a Transjugular Intrahepatic Portosystemic Shunt (TIPS)?

A transjugular intrahepatic portosystemic shunt (TIPS) is an artificial path created in the liver using a small metal device known as a stent. The stent connects the two primary veins of the liver, the portal and hepatic veins. By keeping the connection open between the portal and hepatic vein, it allows blood from the gastrointestinal system to bypass the liver, which reduces pressure in the portal vein and prevents blood from re-routing itself to smaller vessels and creating varices. This procedure can successfully reduce the risk of abdominal and esophageal bleeding as a result of ruptured variceal veins in people with cirrhosis. It can also be utilized to treat the following conditions:

  • Severe cases of ascites and hydrothorax (buildup of fluid in the chest cavity)
  • The engorgement of veins in the wall of the stomach, known as portal gastropathy, which can cause severe internal bleeding
  • Blockages in one or more of the veins that transport blood from the liver to the heart, known as Budd-Chiari Syndrome

The Transjugular Intrahepatic Portosystemic Shunt (TIPS) Procedure

The TIPS procedure is minimally invasive, and usually performed using general anesthesia or local anesthesia with IV sedation. Your interventional radiologist will make a small incision near your jugular vein (right above your collarbone) and insert a narrow catheter into the vein. Using x-ray guidance, the interventional radiologist will thread the catheter through the jugular vein, toward the liver and into the hepatic vein. They will then measure the blood pressure in the hepatic vein to determine the severity of portal hypertension, while confirming that it is the correct diagnosis.

Contrast dye is injected into the hepatic vein so that your doctor can better identify your portal venous system, and a stent is placed, opening a path from the portal vein to the hepatic vein. Once the stent has been placed, the catheter is removed, and your blood pressure in the portal vein is measured again, to confirm that the stent reduced the pressure. Portal venograms are performed as well to ensure that blood is flowing correctly through the TIPS.

The procedure itself typically takes no longer than one or two hours, but this depends on your specific vascular anatomy and the severity of your condition.

After the TIPS procedure, a bandage is applied to the incision – no sutures necessary – and you will keep your head elevated for a few hours. You will be closely monitored at the hospital overnight to ensure that any bleeding is controlled before you are allowed to return home. You should be able to get back to your normal routine within about seven to ten days, and you will have regular follow-up appointments to make sure that the TIPS stent is continuing to function properly.

Benefits of TIPS Surgery

Because TIPS surgery is minimally invasive, the risks that come with open surgery are greatly reduced. Recovery time is shorter, and studies show that variceal bleeding is reduced in more than 90 percent of patients following the procedure. If you require an open surgical bypass or liver transplantation in the future, using a TIPS will ensure that there is no scar tissue in the abdomen, and since the stent used is contained in your liver, it is removed along with it during a transplant.

Risks of TIPS Surgery

Like any medical procedure TIPS surgery carries some minor risks, including:

  • Infection, bruising or bleeding at the incision site
  • Allergic reaction to contrast material
  • Damage to the blood vessels
  • Fever or muscle stiffness in your neck
  • Narrowing of the stent (stenosis)

More serious complications (which happen in less than five percent of patients) include:

  • Blockage of the stent
  • Infection of the stent
  • Severe abdominal bleeding
  • Hepatic vein laceration, resulting in severe bleeding or liver injury
  • Heart irregularities

Again, these are extremely rare occurrences, and every precaution is taken to mitigate possible risks. At your initial consultation, your vascular and interventional radiologist will perform a physical examination and review your medical history to determine if the TIPS procedure is right for you. You will need to let them know about all medications you are taking, including over-the-counter and herbal supplements, to help ensure that you will not experience any interactions with materials used in the surgery.

If you suffer from complications of portal hypertension, it may be time to explore a Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure. Call IVC today at 503-612-0498 and schedule an appointment for a consultation.

* This information about Transjugular Intrahepatic Portosystemic Shunt was reviewed by Dr. Jason R. Bauer. If you have any questions, please don’t hesitate to contact us using the form below.

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Jason Bauer, MD RVT
Michael Pfister, MD RVT

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