What is a transjugular intrahepatic portosystemic shunt?

A transjugular intrahepatic portosystemic shunt (TIPS) is a type of radiologic bypass that helps treat a condition known as portal hypertension, which is most commonly caused by cirrhosis of the liver. As the name implies, there is abnormally high pressure in the portal, or intestinal, circulation. This can lead to one of two complications, either bleeding from swollen veins in the gastrointestinal tract and/or the accumulation of fluid in the chest or abdomen. Sometimes both problems occur at the same time. A TIPS is performed by an interventional radiologist. The procedure is done using intravenous sedation or general anesthesia, depending on your level of illness. Often, symptoms are mild or controlled enough that the procedure can be done electively and patients may go home the next day.

How should I prepare for the procedure?

If you are not already admitted to the hospital, you will be staying at least overnight, and perhaps longer. You will be instructed not to eat or drink anything after midnight the night before your procedure. Certain medications, such as blood thinners, will need to be discontinued several days or more in advance.

How does the procedure work?

The interventional radiologist will be working inside the liver to connect a portal vein branch to one of the hepatic vein branches. The conduit is made up of a metal sleeve, which is called a stent, and a fabric lining. The TIPS is designed to be permanent and will be monitored by periodic ultrasound examinations to make sure that it remains open and functions properly. The procedure ordinarily takes an hour or two to complete, depending on whether abdominal fluid needs to be drained beforehand and whether there are varices that continue to fill after the shunt has been placed, which sometimes must be blocked off in order to prevent re-bleeding.

What can I expect during this procedure?

You will be sedated or completely asleep during the procedure. After numbing the skin above the right collarbone, ultrasound is used to guide entry into the internal jugular vein and a small plastic tube called a catheter is guided with the fluoroscope into the liver and out into one of the hepatic veins. X-ray contrast material is injected and pictures of the veins are taken, as well as pressure measurements, for planning the TIPS shunt. A needle is then guided through the catheter to create the pathway for the shunt. The tract is dilated with a balloon and the conduit is placed.

What should I expect after this procedure?

You will be monitored closely after the procedure. The head of your bed will be kept elevated for a few hours after you return to your room.

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