Transjugular Intrahepatic Portosystemic Shunt

(TIPS)

Trans-jug-u-larr Intra-hep-at-ick Poor-toe-siss-temm-ick Shunt

by Michael Jubinville, MPH

Definition

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.

The Liver

Reasons for Procedure

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.

Possible Complications

All procedures have some risk. Your doctor will review potential problems such as:

Swelling in the brain
Bleeding
Infection
Reaction to the anesthesia or contrast material
Blood clots
Heart failure
High blood pressure in the lungs
Injury to nearby structures
Problems with the shunt
Liver failure

Your chances of problems are higher for:

Smoking
Drinking
Chronic disease such as diabetes or obesity

What to Expect

Prior to Procedure

You may have:

A physical exam
Blood and urine tests
Imaging tests

In the days leading up to your procedure:

Talk to your doctor the medicines you take. You may be asked to stop taking some up to 1 week in advance.
Arrange for a ride and for help at home.
Eat a light meal the night before. Don't eat or drink anything after midnight.

Anesthesia

This may be as:

General anesthesia —you will be asleep
Moderate sedation —will be awake but unable to feel pain

Description of Procedure

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.

How Long Will It Take?

2-3 hours

How Much Will It Hurt?

Anesthesia will prevent pain during the procedure. Medicines will ease pain afterwards.

Average Hospital Stay

Usually 1 night. If you have problems you will need to stay longer.

Postprocedure Care

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:

Washing their hands
Wearing gloves or masks
Keeping your incisions covered

There are also steps you can take to lower your chances of infection such as:

Washing your hands often and reminding visitors and healthcare staff to do the same
Reminding your healthcare staff to wear gloves or masks
Not allowing others to touch your incisions

At Home

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

Call your doctor if any of these occur:

Fever or chills
Redness, swelling, pain, bleeding, or pus from the wound
Yellowing of the skin or eyes— jaundice
Breathing problems
Confusion
Swelling in your belly
Chest pain
Lightheadedness

If you think you have an emergency, call for emergency medical services right away.

RESOURCES:

American Gastroenterological Association
https://www.gastro.org

American Liver Foundation
https://liverfoundation.org

CANADIAN RESOURCES:

Canadian Association of Gastroenterology
https://www.cag-acg.org

Canadian Liver Foundation
https://www.liver.ca

References:

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... . 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:
...(Click grey area to select URL)

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:
...(Click grey area to select URL)
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: 08/13/2018

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