Rutgers Cancer Institute of New Jersey
195 Little Albany Street
New Brunswick, NJ 08903-2681
Trans-jug-u-larr Intra-hep-at-ick Poor-toe-siss-temm-ick Shunt
Transjugular intrahepatic portosystemic shunt (TIPS) changes blood flow in the liver. TIPS connects veins in the liver using a stent to make a tunnel.
The procedure passes tubes down to the liver through a large vein in your neck. The process is tracked using special imaging equipment.
Copyright © Nucleus Medical Media, Inc.
Blood flows from the digestive system to the portal vein of the liver. Blood then passes through the liver where harmful items are removed from the blood. The blood then passes to the hepatic veins, which lead to the heart.
Scarring in the liver lowers the amount of blood that can flow into it. This causes it to back up in the portal vein. Pressure builds in the veins making them larger. Enlarged veins called varices can cause bleeding. It can also cause a buildup of fluids in the belly called ascites.
This procedure is usually done when variceal bleeding or excess fluid in the belly doesn't improve with other treatments. It may also be done for other complications of liver disease.
Transjugular intrahepatic portosystemic shunt (TIPS) decreases the amount of blood flowing into the liver. The shunt makes a new path for some blood to skip the liver by moving from the portal vein straight to the hepatic vein. This decreases the pressure in the portal vein. Unfortunately, it also reduces the ability of the liver to filter harmful chemical out of your blood.
TIPS can’t cure the liver disease. It may help lower bleeding or fluid in the body.
All procedures have some risk. Your doctor will review potential problems such as:
Your chances of problems are higher for:
You may have:
In the days leading up to your procedure:
This may be as:
The doctor will use imaging to see the veins. A contrast material may also be used. This helps make them easier to see.
A small cut will be made in the neck. A tube will be place into a large vein in your neck. The doctor will slowly pass it down into the hepatic vein. There the doctor can measure the pressure in the veins to make sure the shunt is needed.
A contrast material may be used to better show the veins of the liver. A special needle can pass through the tube. This makes a path from the hepatic vein to the portal vein. A metal tube called a stent is placed between the veins. It's opened with a special balloon. Some blood will move through the shunt. The doctor will check the pressure levels again. If the pressure has lowered, the tube will slowly be taken out. If no change is seen, the stent may be fixed.
A bandage will be placed over the incision site.
Anesthesia will prevent pain during the procedure. Medicines will ease pain afterwards.
Usually 1 night. If you have problems you will need to stay longer.
At the Care Center
You will be watched for any signs of serious bleeding.
During your stay, the healthcare staff will lower your chances of infection by:
There are also steps you can take to lower your chances of infection such as:
Strenuous physical activities will need to be avoided for 1-2 weeks.
Bleeding caused by liver damage should stop shortly after procedure. If you had fluid in your belly, it will do down in about a month.
Follow-up appointments will be needed to make sure the stent is working as expected. Scar tissue may also eventually grow over the stent and block it. A second surgery may be needed then.
Call your doctor if any of these occur:
If you think you have an emergency, call for emergency medical services right away.
American Gastroenterological Association
American Liver Foundation
Canadian Association of Gastroenterology
Canadian Liver Foundation
Copelan A, Kapoor B, Sands M. Transjugular intrahepatic portosystemic shunt: indications, contraindications, and patient workup-up. Semin Intervent Radiol. 2014;31(3):235-242.
Hepatic encephalopathy. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116905/Hepatic-encephalopathy. Updated March 1, 2018. Accessed August 13, 2018.
Loffroy R, Favelier S, Pottecher P, et al. Transjugular intrahepatic portosystemic shunt for acute variceal gastrointestinal bleeding: Indications, techniques and outcomes. Diagn Interv Imaging. 2015;96(7-8):745-755.
Patient discharge education—transjugular intrahepatic portosystemic stent (TIPS) & direct intrahepatic portosystemic shunt (DIPS). Stanford Health Care website. Available at: https://stanfordhealthcare.org/content/dam/SHC/clinics/interventional-radiology-clinic/docs/transjugular-direct-intrahepatic-portosystemic-shunt-tips-dips.pdf. Updated January 30, 2014. Accessed August 13, 2018.
Sankar K, Moore C. Transjugular intrahepatic portosystemic shunts. JAMA. 2017;317(8):880. Available at: http://jamanetwork.com/journals/jama/fullarticle/2605801.
Suhocki P, Lungren M, Kapoor B, Kim CY. Transjugular intrahepatic portosystemic shunt complications: prevention and management. Semin Intervent Radiol. 2015;32(2):123-132. Accessed August 13, 2018.
TIPSS (Transjugular intrahepatic portosystemic shunt). University Hospital Southampton website. Available at: http://www.uhs.nhs.uk/OurServices/Radiology-scansandimaging/PatientInformation/TIPSS.aspx. Accessed August 13, 2018.
Transjugular intrahepatic portosystemic shunt. Radiopaedia website. Available at: https://radiopaedia.org/articles/transjugular-intrahepatic-portosystemic-shunt-1. Accessed August 13, 2018.
Transjugular intrahepatic portosystemic shunt (TIPS). RadiologyInfo—Radiological Society of North America website. Available at: https://www.radiologyinfo.org/en/info.cfm?pg=tips#how-its-performed. Updated February 8, 2017. Accessed August 13, 2018.
Transjugular intrahepatic portosystemic stent. University of Washington Medical Center website. Available at: https://www.uwmedicine.org/services/radiology/documents/Articles/Transjugular-Intrahepatic-Portosystemic-Shunt-Procedure.pdf. Accessed March 20, 2017.
Last reviewed May 2018 by EBSCO Medical Review Board Daus Mahnke, MD Last Updated: 8/13/2018