Transhepatic Intrajugular Portosystemic Shunt (TIPS)
TIPS stands for Transhepatic Intrajugular Portosystemic Shunt. During TIPS a doctor places a tube (stent) into your liver. The stent lets your blood flow easily from the inflow (portal) vein to the outflow (hepatic) vein of your liver.
You may need TIPS:
- if you have cirrhosis
- to stop bleeding from varicose veins in your food tube (esophagus) and stomach
- to lessen the build-up of fluid in your stomach cavity (ascites)
- if you are waiting or being considered for a liver transplant
How do I prepare for TIPS?
- Do not eat breakfast the morning of your TIPS.
- Plan to stay in the hospital for a few days after you get your TIPS. You need to stay so the doctor can check for any problems. Bring any personal items you will need to the hospital with you.
- You can get TIPS even if you have a bleeding disorder or a low platelet count. However, you may need to receive blood before TIPS to lower your risk of bleeding during the procedure.
What will happen during TIPS?
- The doctor will talk to you about TIPS and answer any questions you may have. You should know what TIPS is, why you are having TIPS and the possible risks. You will be asked to sign a consent form. Your signature gives the doctor permission to do TIPS.
- TIPS is done in a small operating room in the X-ray department. You lie down on a table and are covered with a sheet. The doctor cleans your neck (usually the right side). Your chest and face are covered with sterile towels to stop infection. Your nose and eyes are also covered.
- The skin over the vein in your neck is numbed with medicine. The doctor places a needle into your neck vein. You should not feel the needle.
The needle is removed and a long thin tube (catheter) is put into the vein. The doctor gently pushes the catheter through the major vein in your chest, through your heart and into the hepatic vein of your liver.
- A needle is pushed through the catheter. The needle passes from the hepatic vein, through your liver, into the portal vein. A guide wire is passed through the needle and into the portal vein.
- The doctor removes the needle. The guide wire is used to pass a balloon catheter into the portal vein. The balloon is blown-up and enlarges the path between the two veins.
- The doctor removes the balloon catheter. A stent is passed along the wire and joins the hepatic vein to the portal vein. The stent is a narrow tube of mesh wire.
- Once the stent is in place, the doctor opens it so that blood coming into the liver can easily flow through the stent and out of your liver.
- The wire is removed. Your TIPS is done.
- After TIPS is placed, X-ray pictures are taken to make sure the TIPS position is okay. The doctor may leave a small plastic tube in your neck vein for a few days in case the TIPS needs to be adjusted.
What will happen after TIPS?
- When TIPS is placed to stop bleeding of varicose veins or to lessen the build-up of fluid in the stomach cavity, the results are good. However, the inside of the TIPS stent can become narrowed or blocked.
- If the stent becomes narrowed or blocked, then you may become sick again. Your doctors will have a plan to check your TIPS and make needed changes before any new problems happen.
- At present, the best way to check your TIPS is the abdominal ultrasound. During the ultrasound, lubricant is applied to the skin of your abdomen and a microphone measures the speed of blood flow through the TIPS. There are no needles needed to check your TIPS.
- If ultrasound shows that blood flow is not good, the doctor will directly measure the blood flow through your TIPS. The procedure for direct measurement is like the procedure used when your TIPS was originally placed. About 50% of patients with TIPS need correction of the TIPS some time during the first 12 months after the procedure. Correction does not usually require you to stay in the hospital.
Over the next 24 hours:
You do not have to take care of your TIPS in any special way.
Call your doctor immediately if you get confused, have undue sleepiness, bleeding (vomiting blood or black stools), build-up of fluid in your stomach, tiredness, shortness of breath or fevers. Any of these symptoms can happen if your TIPS is not working properly.
What are the risks to TIPS?
TIPS is very safe; however, a few people may have problems.
Bleeding may occur where the needle is placed in your neck or in your liver. Bleeding is rare. If you do bleed, you should not need a blood transfusion. Bleeding is usually easy to handle.
About 30% of patients who have TIPS become increasingly confused afterward. The confusion is called hepatic encephalopathy. Hepatic encephalopathy is usually mild and is treated with medicine taken by mouth.
Sometimes TIPS causes a further decrease in liver function because most of the blood flowing into the liver now flows through the tube. If this happens, you will need a liver transplant sooner. As a result, your life expectancy may be shorter than expected. TIPS can also cause kidney damage and anemia.