Transjugular Intrahepatic Portosystemic Shunt

What is a transjugular intrahepatic portosystemic shunt?

Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure for improving blood flow through a diseased liver. It creates a new path, or tunnel, for blood flow between the portal vein and one of the hepatic veins. It puts a small metal tube called a stent into the tunnel to keep it open. The portal vein carries blood from the intestines to the liver. The hepatic veins bring blood from the liver back to the heart. TIPS can improve blood flow to and from the liver.

When is it performed?

TIPS may be done when you have complications from liver disease, such as portal hypertension. Portal hypertension is increased blood pressure in the portal vein. For example, you may have high blood pressure in the portal vein if you have cirrhosis. Scar tissue caused by this liver disease may block blood flow between the portal vein and a hepatic vein, increasing pressure in the portal vein. High blood pressure in the portal vein causes blood to move backward from the liver to the bowel. This backwards flow of blood makes the veins swell, and fluid collects in the chest and belly. The increased pressure can cause bleeding of swollen veins in the esophagus--a very dangerous condition.

The shunt reduces pressure in your veins by providing a new path for blood to flow from the intestines, through the liver, and back to the heart. This helps the veins shrink back to normal size and can help stop or prevent accumulation of fluid in the abdomen. It also lowers the risk of bleeding.

Several types of shunts may be placed surgically. TIPS is a way to place a shunt without open abdominal surgery.

How do I prepare for this procedure?

• Tell your healthcare provider about all of the medicines that you are taking, including prescription and nonprescription medicines and herbal supplements.
• Tell your healthcare provider if you have any allergies, particularly to anesthesia.
• Tell your healthcare provider if you are or may be pregnant.
• Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery and other procedures. They are also more likely to have breathing problems during a procedure. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before the procedure.
• If you need a minor pain reliever in the week before the procedure, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during the procedure. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your procedure.
• Your healthcare provider will tell you which medicines you should take the day of the procedure.
• Do not eat anything after midnight before your procedure. It’s OK to drink clear fluids the day of your procedure.
• Find someone to drive you home after the procedure.
• Plan for your care and recovery after the procedure, especially if you are to have general anesthesia. Allow for time to rest. Try to find other people to help you with your day-to-day duties.
• Follow any other instructions your provider gives you.

What happens during the procedure?

Usually you are given a local anesthetic to numb the area where the needle will be inserted in your neck. In some cases you may be given a general anesthetic, which will put you to sleep and prevent you from feeling pain during the operation.

Your healthcare provider (usually a radiologist) will puncture the skin in your neck with a needle and use ultrasound to guide the needle into your jugular vein. Then with catheters and special X-rays using contrast dye, your provider will use a cutting needle to create a tunnel in the liver. The tunnel will connect the portal vein to one of the hepatic veins. A catheter will be used to insert the stent. The stent helps keep the tunnel open.

The procedure takes 1 to 3 hours.

What happens after the procedure?

After the TIPS procedure:

• For several hours after the procedure you are not allowed to eat or drink and may get intravenous (IV) fluids.
• You will stay in the hospital for at least 1 to 2 days.
• Your heart and lungs will be monitored for several hours after the procedure.
• You will be given medicines to help control any pain after the surgery.
• You will have follow-up blood tests and ultrasounds to check that the stent is open and working.
• You may need to have a diet that is low in salt and protein. Follow the diet recommended by your healthcare provider.
• Your provider may prescribe a laxative to soften your bowel movements.

Be sure to keep all follow-up appointments with your healthcare provider.

What are the benefits of this procedure?

The benefits of the TIPS procedure:

• It has fewer risks than a surgical shunt or bypass but gives the same results.
• It has a shorter recovery time than open abdominal surgery.
• You just have a small nick in the skin rather than a surgical incision.

What are the risks associated with the procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• A regional anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. Regional anesthesia is considered safer than general anesthesia.
• You may get an infection.
• You may get an allergic reaction to the injected contrast material.
• There is a risk of bleeding and damage to blood vessels.
• You may have a stiff neck or bruising where the catheter is inserted.
• The shunt may narrow or become blocked, requiring another procedure.
• A condition called encephalopathy, which often happens with severe liver disease, may get worse. When TIPS increases blood flow through the liver, it reduces blood flow to the liver cells. This allows the toxins normally carried away from the liver to build up and cause a comalike state to develop. Discuss with your healthcare provider the likelihood that you may develop encephalopathy.

When should I call my healthcare provider?

Call your provider right away if:

• You have a fever of 100°F (37.8°C) or higher You develop severe abdominal pain.
• You become lightheaded and feel like you are going to faint.
• You become confused and unable to think right.
• You are sleeping all the time.

Call during office hours if:

• You have any other questions or concerns.