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TIPS (Transjugular Intrahepatic Portosystemic Shunt)

Liver showing stent connecting portal vein and hepatic vein.

A healthy liver does many important
jobs. It processes alcohol, food, and medicines. It makes digestive juices, helps
with
blood clotting, and helps your body fight infection. The portal vein is the large
vessel
that carries most of the blood from the intestine to the liver. Certain diseases or
a
blockage in the portal vein can cause blood pressure to rise in this vein. This often
leads
to fluid buildup in the belly (abdomen) and
high pressure in
dilated veins which can cause massive bleeding. The TIPS procedure helps
ease the pressure in the portal vein. It also eases pressure in the veins of the stomach,
esophagus, and bowel and lowers the risk of bleeding from these veins. The procedure
is
done by a specially trained doctor called an interventional radiologist.

Although the TIPS procedure can lower
portal pressure, it may make liver failure worse in people with severe liver disease.
Encephalopathy can happen if too much blood bypasses the liver after a TIPS. Encephalopathy
comes from toxins in the bloodstream that are normally filtered by the liver. The
toxins
build up in the brain. This can cause mental confusion, personality changes, memory
loss,
and sleepiness. Encephalopathy can be treated by having the stent in the bypass revised
or
completely blocking it off.

Getting ready for your procedure

Follow any instructions you are given to get ready. This includes any directions you’re
given for not eating or drinking before the procedure.

Tell your healthcare provider if:

You are pregnant or think you
may be pregnant
You are breastfeeding
You have any medical conditions
You are allergic to X-ray dye
(contrast medium) or other medicines

Tell your provider about all medicines you take. You may need to stop taking some
or all of them before the test. This includes:

All prescription medicines
Over-the-counter medicines such as aspirin or ibuprofen
Illegal drugs
Herbs, vitamins, and other supplements

During your procedure

TIPS is a complex procedure. Your healthcare provider will explain it to you. Below
is a summary of what will happen during the procedure.

You will be under general anesthesia or conscious sedation. You will have an IV (intravenous)
line to give you fluid and medicines. You will also be given medicine through
the IV to help you relax.
Medical staff will inject a
local anesthesia to numb the skin at the incision site. The healthcare provider
will make a very small cut (incision) on the right side of your neck. The provider
will put a needle with a guide wire attached through the incision into a
vein.
The provider will inject
X-ray dye into the vein. This helps the vein show up clearly on X-ray images.
Using these images as a guide, the radiologist moves the needle into another large
vein in the liver (the hepatic vein).
The provider will push the
needle through the wall of the hepatic vein into the portal vein. A thin flexible
tube (catheter) is threaded over the guide wire. The provider will move a metal
mesh cylinder (stent) through the catheter and place it over the needle between
the hepatic and portal veins. The stent creates a passageway (shunt) between the 2
veins. Blood flows freely through the shunt into the hepatic vein. This eases the
high pressure in the portal vein.
When the procedure is finished, the needle, wire, and catheter are taken out.
The stent stays in place to hold the shunt open.

After your procedure

Your blood pressure and pulse will be watched closely for several hours after the
procedure.
You will not be able to eat or drink for several hours after the procedure.
The catheter in your neck may stay in place for a day or longer.
You may have 1 or more ultrasound tests to check how well the shunt is working.
You will stay in the facility or hospital overnight for observation.