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Transjugular Intrahepatic Portosystemic Shunt (TIPS)
Transjugular Intrahepatic Portosystemic Shunt (TIPS) is a tract created within the liver using x-ray guidance to connect two veins within the liver. The shunt is kept open by the placement of a small, tubular metal device commonly called a stent.
During a TIPS procedure, interventional radiologists use image guidance to make a tunnel through the liver to 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.
What are some common uses of the procedure?
1) Variceal bleeding, bleeding from any of the veins that normally drain the stomach, esophagus, or intestines into the liver.
2) Portal gastropathy, an engorgement of the veins in the wall of the stomach, which can cause severe bleeding.
3) Severe ascites (the accumulation of fluid in the abdomen) and/or hydrothorax (in the chest).
Budd-Chiari syndrome, a blockage in one or more veins that carry blood from the liver back to the heart.
How should I prepare?
You should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to local anesthetic medications, general anesthesia or to contrast materials containing iodine (sometimes referred to as "dye" or "x-ray dye"). Your physician may advise you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners for a specified period of time before your procedure.
Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby. See the Safety page for more information about pregnancy and x-rays
How does the procedure work?
A TIPS reroutes blood flow in the liver and reduces abnormally high blood pressure in the veins of the stomach, esophagus, bowel and liver, reducing the risk of bleeding from enlarged veins across the esophagus and stomach.
A TIPS procedure involves creating a pathway through the liver that connects the portal vein (the vein that carries blood from the digestive organs to the liver) to a hepatic vein (one of three veins that carry blood from the liver to the heart).
A stent placed inside this pathway keeps it open and allows some of the blood that would ordinarily pass through the liver to bypass the liver entirely, reducing high blood pressure in the portal vein and the associated risk of bleeding from enlarged veins.
How is the procedure performed?
Image-guided, minimally invasive procedures such as a TIPS are most often performed by a specially trained interventional radiologist in an interventional radiology suite or occasionally in the operating room. Some interventional radiologists prefer performing this procedure while the patient is under general anesthesia, while some prefer conscious sedation for their patient. The advantage of general anesthesia is that the patient will not feel anything.
You will be positioned on your back. You may be connected to monitors that track your heart rate, blood pressure and pulse during the procedure. This procedure is usually completed in an hour or two but may take up to several hours depending on the complexity of the condition and vascular anatomy.
To know more on improvements in the field of TIPS or TIPS related research work visit American Journal of Interventional Radiology website.
