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TIPS (Transjugular Intrahepatic Portosystemic Shunt)

Talk to your doctor about the risks and possible complications of the TIPS procedure.

Although the TIPS procedure has shown to decreased portal pressure, it may worsen liver failure in people with severe liver disease. Encephalopathy, which comes from toxins in the blood stream normally filtered by th eliver, may occur when too much blood bypasses the liver after a TIPS. Having the stent in the bypass revised or completely blocking it off may be necessary to treat encephalopathy.

A healthy liver does many vital jobs. It processes alcohol, food, and medications. It makes digestive juices, helps with blood clotting, and helps the 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 an increase in blood pressure in this vein. This often leads to fluid buildup in the abdomen (ascites) and massive bleeding. The TIPS procedure helps relieve the pressure in the portal vein. The procedure is done by a specially trained doctor called an interventional radiologist.

Liver showing stent connecting portal vein and hepatic vein.

Preparing for the procedure

Follow any instructions you are given to prepare, including:

  • Do not eat or drink for 6 hours before the procedure.

  • Tell the technologist what medications, herbs, or supplements you take; if you are, or may be, pregnant; or if you are allergic to contrast medium (x-ray dye) or other medications.

During the procedure

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

  • You will have an IV (intravenous) line to give you fluid and medications. You will be given medication through the IV to help you relax.

  • Local anesthesia is injected to numb the skin at the incision site. A very small incision is made on the right side of your neck. A needle with a guide wire attached is inserted through the incision into a vein.

  • Contrast medium is injected into the vein. This helps the vein show clearly on x-ray images. Using these images as a guide, the radiologist moves the needle into the hepatic vein (another large vein in the liver).

  • The needle is pushed through the wall of the hepatic vein into the portal vein. A catheter (thin, flexible tube) is threaded over the guide wire. A stent (metal mesh cylinder) is moved through the catheter and placed over the needle between the hepatic and portal veins. The stent creates a shunt (passageway) between the two veins. Blood flows freely through the shunt into the hepatic vein, relieving the high pressure in the portal vein.

  • When the procedure is finished, the needle, wire, and catheter are removed. The stent remains in place to hold the shunt open.

After the procedure

  • Your blood pressure and pulse will be monitored 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 remain in place for a day or longer.

  • You may have one or more ultrasound tests to check how well the shunt is working.


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