What You Need to Know About The
Transjugular Intrahepatic Portosystemic Shunt (TIPS)
What is the transjugular intrahepatic portosystemic shunt procedure?
The transjugular intrahepatic portosystemic shunt (TIPS) is a radiologic
procedure in which a stent (a tubular device) is placed in the middle of the
liver to reroute the blood flow.
During the procedure, a radiologist makes a tunnel through the liver with a
needle, connecting the portal vein (the vein that carries blood from the
digestive organs to the liver) to one of the hepatic veins (the three veins that
carry blood from the liver). A metal stent is placed in this tunnel to keep the
track open.
The TIPS procedure is not a surgical procedure - the radiologist performs the
procedure within the vessels in the X-ray room under X-ray guidance.
Why do I need to have the TIPS procedure?
Diagnostic tests confirm that you have portal hypertension. Portal
hypertension is a condition characterized by increased pressure in the portal
vein. The increase in pressure is caused by a blockage in the blood flow
throughout the liver.
The TIPS procedure is used to manage the complications of portal
hypertension, including:
- Variceal bleeding - varices are large veins that develop (usually across
the esophagus and stomach) when there is a blockage in the blood flow
throughout the liver. Varices are fragile and can bleed easily.
- Ascites - an accumulation of fluid in the abdomen.
The TIPS procedure reroutes blood flow in the liver and reduces pressure in
all abnormal veins, not only in the stomach and esophagus, but also in the bowel
and the liver.
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Portal Hypertension before the TIPS procedure is performed.
Portal hypertension causes blood flow to be forced backward, causing
veins to enlarge and varices to develop across the esophagus and stomach
from the pressure in the portal vein. The backup of pressure also causes
the spleen to become enlarged. |
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After the TIPS procedure is performed.
A radiologist makes a tunnel through the liver with a needle,
connecting the portal vein to one of the hepatic veins. A metal stent is
placed in this tunnel to keep the track open.
The shunt allows the blood to flow normally through the liver to the
hepatic vein. This reduces portal hypertension, and allows the veins to
shrink to normal size, helping to stop variceal bleeding. |
What tests are required before the procedure?
Before the TIPS procedure, you will have had the following tests to
determine the extent and severity of your portal hypertension:
- Evaluation of your medical history n Galactose liver function test
- A physical examination n Ultrasound or angiogram
- Blood tests n Endoscopy
Before the TIPS procedure
You will meet with the nurse clinician or resident and your physician to
discuss the steps of the procedure. They will be available to answer any
questions you may have.
Before the procedure, please follow these guidelines:
EATING AND DRINKING
- DO NOT eat anything after midnight the evening before the procedure.
- You may drink clear liquids on the day of the procedure.
MEDICATIONS
- Ask your physician if you should take your daily medications before the
procedure.
- Note: Do not discontinue any medications without first consulting with
your physician.
On the day of the procedure
- Please do not bring valuables such as jewelry or credit cards.
- An intravenous tube (IV) will be inserted in your arm to deliver fluids
and medication.
- The procedure lasts 1 to 3 hours. You should expect to stay in the
hospital 2 to 3 days after the procedure. Please bring a robe and any other
items you would like to make your stay more comfortable.
A NOTE TO FAMILIES
Family members and friends are invited to wait for you in the Family Waiting
Lounge. This waiting area has a play room for small children, a television,
reading materials and comfortable chairs.
Because waiting times can be long, visitors are encouraged to come and go as
necessary. The Clinic has several cafeterias and restaurants, a gift shop, and a
Health Information Library that may be of interest. We ask visitors to sign in
and out of the waiting area so we can find them if necessary.
After the TIPS procedure
- You will be admitted to the hospital where you will be observed closely.
- Before you are discharged, you will have an ultrasound to determine the
effectiveness of the shunt. If the shunt appears to be functioning properly,
you will be allowed to go home.
What are the potential complications of this procedure?
- Shunt narrowing or occlusion (blockage). Follow-up ultrasounds are
performed frequently after the TIPS procedure to detect these complications.
The signs of occlusion include increased ascites or rebleeding. This
condition can be treated by a radiologist who re-expands the shunt with a
balloon or repeats the procedure to place a new stent.
- Encephalopathy -- mental changes caused by abnormal functioning of the
brain that occur with severe liver disease. Encephalopathy can be worse when
blood flow to the liver is reduced by TIPS, which may result in toxic
substances reaching the brain without being metabolized first by the liver.
This condition can be treated with medications, diet or by revising the
shunt.
Follow-up medical care will be done in the TIPS clinic
- Ten days to 2 weeks after your hospital discharge date, you will meet with
the surgeon or hepatologist to evaluate your progress. Lab work will be done
at this time.
- Six weeks after the TIPS procedure (and again 3 months and 6 months after
the procedure), you will have an ultrasound so your physician can check that
the shunt is functioning properly. You will have an angiogram only if the
ultrasound indicates that there is a problem. You will also have lab work
done at these times.
- Twelve months after the procedure, you will have an ultrasound, angiogram
and lab work to make sure the shunt is working properly. You will also visit
with your physician at this time.
- If the shunt is working well, every 6 months after the first year of
follow-up appointments you will have an ultrasound, lab work and you will
visit with your physician.
- More frequent follow-up visits may be necessary, depending on your
condition.
What do I need to do to maintain my health after the procedure?
- Attend all follow-up appointments, as scheduled, to ensure that the shunt
is properly functioning.
- Be sure to follow the dietary recommendations provided by your health care
providers.
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