Transjugular Hepatic Portosystemic Shunt TIPS

What is TIPS used for?

TIPS procedures are performed in order to decrease the high blood pressure that has developed in patients with severe liver disease in their portal venous system. By decreasing that pressure, it has the effect of potentially decreasing bleeding complications that can result from that increased pressure or decrease the development of fluid within the abdomen, what we call a ascites, as a result of the liver disease.

What can I expect during TIPS?

When a TIPS procedure is performed, you will feel a little bit of burning pain when we provide the local anesthetic in the skin in your neck. You may also feel some pain in your abdomen when we pass through the liver, if you are awake. If you are under general anesthesia, you will not feel any of this.

What can I expect after TIPS?

After the procedure, then the devices are removed, and then you will be usually sent to the intensive care unit, or possibly to your hospital room, in order to recover.

How is TIPS performed?

TIPS procedures can be preformed with either intravenous or general anesthesia. The entry into the blood vessels is typically by way of the neck. The main blood vessel, the jugular vein in the neck is entered after local anesthetic is applied to the skin and to the soft tissues. The devices that are used for the procedure are then passed into the blood vessels, into the liver and then a special needle is used to pass into the main portal vein, which is another set of blood vessels within the liver, through the liver tissue. After that is performed, the tract through the liver tissue is dilated using a balloon angioplasty catheter and a special kind of a metal stent is placed in order to keep that half way open. This allows for then blood pressure from the portal vein to enter directly into the padded vein and decrease the pressure that's in that portal vein.

What does equipment used for TIPS look like?

The equipment that is used involves thin plastic tubes and a special kind of a needle which allows us to pass through the liver substance, in order to create the tract between your liver veins, your hepatic veins, and the portal venous system, which is another set of blood vessels within the liver.

What are the benefits of TIPS?

The benefits of TIPS lies in the ability to perform a procedure which can be life saving in opening up a passageway between the portal vein and hepatic vein to decrease the blood pressure without an open surgery. In the past procedures were performed to decrease the blood pressure within the portal vein by having a major abdominal surgery being performed in order to connect the portal vein to one of the major blood vessels in your body, your vena cava.

What are the risks of TIPS?

TIPS procedures are performed in patients who are already very ill they have a severe liver disease which is usually leading to this potential procedure. The risks of the procedure can include bleeding or infection or injure to the liver bleeding into the abdomen or the potential of what we call hepatic encephalopathy. The benefits of the procedure outweigh the potential risks in that we can frequently perform these procedures with a very low complication rate and determine whether or not decreasing the pressure within your portal veins will help you get through the problems you've been having with either bleeding or ascites.

What are the limitations of TIPS?

TIPS procedures however, cannot be performed on patients with some forms of liver disease, which are extremely severe. If they have blockages of their bile ducts or if they have such severe end stage liver disease that they already have insefolopovy of if they can't have bleeding problems that can't be corrected with the administration of medications or some blood products, then the procedure can be too dangerous to perform.