TIPS (Transjugular Intrahepatic Portosystemic Shunt)

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

Although the TIPS procedure can lower portal pressure, it may make liver failure worse in people with severe liver disease. Encephalopathy can happen if too much blood bypasses the liver after a TIPS. Encephalopathy comes from toxins in the bloodstream that are normally filtered by the liver. Encephalopathy can be treated by having the stent in the bypass revised or completely blocking it off.

Liver showing stent connecting portal vein and hepatic vein.

Getting ready for your procedure

Follow any instructions you are given to get ready. This includes any directions you’re given for not eating or drinking before the procedure.

Tell your healthcare provider if:

  • You are pregnant or think you may be pregnant

  • You are breastfeeding

  • You are allergic to X-ray dye (contrast medium) or other medicines

Tell your provider about all medicines you take. You may need to stop taking some or all of them before the test. This includes:

  • All prescription medicines

  • Over-the-counter medicines such as aspirin or ibuprofen

  • Street drugs

  • Herbs, vitamins, and other supplements

During your procedure

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

  • You will have an IV or intravenous line put into a vein in your arm or hand. This is to give you fluid and medicines.

  • You will be given medicine through the IV to help you relax. You may have medicine that puts you into a deep sleep (general anesthesia). Or you may be given medicine that helps you to to relax. This is called sedation.

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

  • X-ray dye or contrast medium is injected into the vein. This helps the vein show up clearly on X-ray images. Using these images as a guide, the provider moves the needle into another large vein in the liver called the hepatic vein.

  • The needle is pushed through the wall of the hepatic vein into the portal vein. A thin, flexible tube called a catheter is threaded over the guide wire.

  • A metal mesh tube called a stent is moved through the catheter. It is placed over the needle between the hepatic and portal veins. The stent creates a pathway or shunt between the 2 veins. Blood flows freely through the shunt into the hepatic vein. This eases the high pressure in the portal vein.

  • When the procedure is done, the needle, wire, and catheter are taken out. The stent stays in place to hold the shunt open.

After your procedure

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

  • You may have 1 or more ultrasound tests to check how well the shunt is working.

  • You will stay in the facility or hospital overnight for observation.