Transjugular Intrahepatic Portosystemic Shunt

Transjugular Intrahepatic Portosystemic Shunt or TIPS is a procedure that uses imaging guidance to create a connection between two large veins in the liver, the portal vein and the hepatic vein. This helps blood bypass the abnormal liver so that it can return to the heart more easily. A small metal device called a stent is placed to keep the connection open. TIPS is performed to reduce the risk of internal bleeding from the stomach and esophagus in patients with cirrhosis. TIPS may also reduce the accumulation of fluid in the abdomen or lungs.

When is this procedure recommended?

A TIPS is used to treat the complications of portal hypertension, including:

  • Variceal bleeding, bleeding from enlarged veins that normally drain the stomach, esophagus, or intestines into the liver
  • Portal gastropathy, an engorgement of the veins in the wall of the stomach, which can cause severe bleeding
  • Severe ascites (the accumulation of fluid in the abdomen) and/or hydrothorax (in the chest)
  • Budd-Chiari syndrome, a blockage in one or more veins that carry blood from the liver back to the heart

How is the procedure performed?

During a TIPS procedure, interventional radiologists use image guidance to make a tunnel through the liver to connect the portal vein (the vein that carries blood from the digestive organs to the liver) to one of the hepatic veins (the veins that carry blood out of the liver back to the heart). A stent is then placed in this tunnel to keep the pathway open. 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. 

What are the benefits?

  • TIPS is a minimally invasive procedure that typically has a shorter recovery time than surgery
  • No large surgical incision is necessary—only a small nick in the skin that does not need stitches
  • TIPS should have less of an effect on candidacy for future liver transplantation versus open surgical bypass 
  • Studies have shown that this procedure is successful in reducing variceal bleeding in more than 90 percent of patients


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