Transjugular Intrahepatic Portosystemic Shunt (TIPS)

What is it?

Transjugular intrahepatic portosystemic shunt (TIPS) is surgery to make new attachments between blood vessels in the liver.

What is it for?

This surgery is performed for serious liver disorders where blood is unable to flow easily through it. Blood unable to flow through the liver can cause ruptures and fluid buildup in various body parts. TIPS helps blood to move more easily in the liver and also in the esophagus, intestines, stomach and heart.

Patients needing TIPS typically have portal hypertension, increased pressure in the portal vein system. The portal vein system carries blood from the digestive organs to the liver. A tunnel, aided by a stent to keep it open, is made in the liver to connect the portal vein to one of the three hepatic veins transporting blood away from the liver to the heart.

How to prepare

• Talk with your doctor all about medications you are taking and allergies you have
• You may be instructed to stop taking some medications prior to the surgery
• You will be given instructions about what to eat and drink prior to the procedure
• You will probably stay in the hospital for several days

Risks

• Infection at the incision site
• Allergic reaction or kidney failure due to contrast material
• Kidney failure for patients with poor kidney function
• Bruising or bleeding at the incision site

What happens during?

• Your heart rate and blood pressure will be monitored
• You’ll receive I.V. medication through a vein in your arm or hand to sedate you and make you feel sleepy
• A general anesthetic will be used for the incision site, an area just above the right collarbone
• Using ultrasound, your doctor will identify the internal jugular vein, above the right collarbone, and guide a long, thin, hollow plastic tube called a catheter into the vessel
• Using X-rays, your doctor will move the catheter toward the liver and into a hepatic vein. Pressure is gauged in the hepatic vein and the heart to look for hypertension and other conditions. Contrast material is injected in the hepatic vein to help the doctor identify the portal venous system. A TIPS needle, a long needle extending from the neck to the liver, is used to get access from the hepatic vein to the portal system. A stent is placed extending from the portal vein into the hepatic vein. The stent is expanded using a balloon creating a tunnel for proper blood flow.
• The balloon is deflated and removed along with the catheter
• The procedure usually lasts from one to two hours

What happens after?

• You will be monitored closely for a few hours before going to a hospital room
• You may be able to go home the next day following the surgery
• You may be able to resume normal activities after 7 to 10 days

Side effects

• Fever
• Muscle stiffness or bruising in the neck at the incision site

More information:

• RadiologyInfo.org
• U.S. National Library of Medicine