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Transjugular intrahepatic portosystemic shunt (TIPS)

TIPS; Cirrhosis - TIPS; Liver failure - TIPS

Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure to create new connections between two blood vessels in your liver. You may need this procedure if you have severe liver problems.

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Transjugular intrahepatic portosystemic shunt

Description

This is not a surgical procedure. It is done by an interventional radiologist using x-ray guidance. A radiologist is a doctor who uses imaging techniques to diagnose and treat diseases.

You will be asked to lie on your back. You will be connected to monitors that will check your heart rate and blood pressure.

You will probably receive local anesthesia and medicine to relax you. This will make you pain-free and sleepy. Or, you may have general anesthesia (asleep and pain-free).

During the procedure:

This new pathway will allow blood to flow better. It will ease pressure on the veins of your stomach, esophagus, intestines, and liver.

Why the Procedure Is Performed

Normally, blood coming from your esophagus, stomach, and intestines first flows through the liver. When your liver has a lot of damage and there are blockages, blood cannot flow through it very easily. This is called portal hypertension (increased pressure and backup of the portal vein). The veins can then break open (rupture), causing serious bleeding.

Common causes of portal hypertension are:

When portal hypertension occurs, you may have:

This procedure allows blood to flow better in your liver, stomach, esophagus, and intestines, and then back to your heart.

Risks

Possible risks with this procedure are:

Rare risks are:

Before the Procedure

Your doctor may ask you to have these tests:

Tell your health care provider:

On the day of your procedure:

After the Procedure

After the procedure, you will recover in your hospital room. You will be monitored for bleeding. You will have to keep your head raised.

There is usually no pain after the procedure.

You will be able to go home when you feel better. This may be the day after the procedure.

Many people get back to their everyday activities in 7 to 10 days.

Your doctor will probably do an ultrasound after the procedure to make sure the stent is working correctly.

You will be asked to have a repeat ultrasound in a few weeks to make sure that the TIPS procedure is working.

Outlook (Prognosis)

Your radiologist can tell you right away how well the procedure worked. Most people recover well.

TIPS works in about 80% to 90% of portal hypertension cases.

The procedure is much safer than surgery and does not involve any cutting or stitches.

Related Information

Hepatic vein obstruction (Budd-Chiari)
Cirrhosis
Alcoholic liver disease
Ascites
Loss of brain function - liver disease
Portacaval shunting
Stent
Cirrhosis - discharge

References

Darcy MD. Transjugular intrahepatic portosystemic shunting: indications and technique. In: Jarnagin WR, ed. Blumgart's Surgery of the Liver, Biliary Tract, and Pancreas. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 87.

Dariushnia SR, Haskal ZJ, Midia M, et al. Quality improvement guidelines for transjugular intrahepatic portosystemic shunts. J Vasc Interv Radiol. 2016;27(1):1-7. PMID: 26614596 www.ncbi.nlm.nih.gov/pubmed/26614596.

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Review Date: 1/4/2019  

Reviewed By: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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