The liver’s primary role is to filter blood coming from the digestive system -- the stomach, the intestines, and the spleen -- before it reaches the heart. Blood is carried from the digestive organs to the liver by the portal vein, and three hepatic veins carry filtered blood away from the liver.
Patients with liver disease such as cirrhosis (scarring of the liver) often have increased pressure within their portal vein. When scar tissue blocks blood flow from the portal vein to the hepatic veins, this is called portal hypertension. This condition can lead to enlarged stomach and esophageal veins called varices. Varices can burst and create dangerous internal bleeding. A TIPS procedure creates an artificial channel (shunt) to directly connect the portal vein with the hepatic vein, redirecting blood to reduce pressure and let the varices heal.
Why a Transjugular Intrahepatic Portosystemic Shunt (TIPS) Procedure is Performed
TIPS is performed to treat complications of portal hypertension. Beyond bleeding varices, portal hypertension patients may also suffer from the following conditions that can be improved or resolved with a TIPS procedure:
- Ascites (significant build-up of fluid in the abdomen or chest)
- Budd-Chiari syndrome (a blockage in a hepatic vein)
- Gastropathy (enlarged stomach veins that may cause bleeding)
What to Expect During a Transjugular Intrahepatic Portosystemic Shunt (TIPS) Procedure
TIPS is a minimally-invasive procedure that uses a stent (a metal tube covered in fabric) to create a pathway (the shunt) between the portal and hepatic veins. TIPS is performed by an interventional radiology physician who relies on imaging guidance to safely access the jugular vein (in the neck).
TIPS is performed under general anesthesia. After making a small incision, the physician places an intravenous (IV) line into the jugular vein. Next, a catheter (thin plastic tube) is threaded through to the liver. X-ray imaging helps the provider insert the catheter safely. Prior to accessing a hepatic vein, blood pressure is measured and contrast (dye) is injected for clear visualization of the portal vein system. Continuing to use imaging for guidance, the interventional radiologist uses a long needle to place the stent into the tunnel the catheter created. The stent remains in place to keep the pathway open and redirect blood through the shunt and into the hepatic vein. This relieves the high pressure in the portal vein.
At the end of the procedure, pressure is re-measured to see if it has been reduced. If there is concern that about the post-procedure pressure level, additional testing may be needed to to ensure blood is flowing as expected.
Risks and Benefits of a Transjugular Intrahepatic Portosystemic Shunt (TIPS)
The major benefit of TIPS for a liver disease patient with bleeding varices is the successful reduction in internal bleeding. TIPS is preferable to surgical stent placement since it carries fewer risks than an open surgery. The relatively short recovery time is another significant benefit of TIPS, as is the small incision site that is less prone to infection. For patients who are liver transplant candidates, the minimally invasive approach does not cause problematic scar tissue that could lead to complications during a surgical transplant.
The risks of TIPS are largely the same as the risks of any interventional radiology procedure. They may include infection; allergic reaction to the contrast dye used for imaging; and bleeding, bruising, or blood vessel damage caused by the catheter.
How to Prepare for a Transjugular Intrahepatic Portosystemic Shunt (TIPS)
There are a number of pre-procedural tests that may be required prior to a TIPS placement. These include bloodwork to measure liver and kidney function as well as platelet levels (platelets helps blood to clot). Cardiac imaging may also be ordered to evaluate the patient’s heart health. If ascites are present, a sample of the fluid may be taken to ensure there are no infectious cells that could spread during the procedure.
As with any procedure, the medical care team will review known allergies and current medications. Patients may be asked to pause some medications such as blood thinners. Patients should plan for a one to two day stay in the hospital following TIPS.
Post Transjugular Intrahepatic Portosystemic Shunt (TIPS) Procedure
Recovery following discharge from the hospital is relatively quick, with most patients resuming normal activities the next day. About a week following the procedure, the patient will need to have a first follow-up ultrasound to evaluate how the shunt is working. If blood debris accumulates in the shunt, which sometimes happens, the patient may need to have an outpatient procedure to re-open the shunt to keep it working effectively. Periodic ultrasounds will help with ongoing monitoring for any blockage.