A transjugular intrahepatic portosystemic shunt (TIPS) procedure is a treatment method used to lower portal hypertension, or excessive pressure in your portal vein.
This vein is responsible for carrying blood from your abdomen to your liver. Excess pressure can lead to significant bleeding and fluid buildup in your abdomen, which is known as ascites.
Keep reading to find out more about the TIPS procedure, including why you might need it, how doctors perform it, and potential side effects that could result from this procedure.
A TIPS procedure involves creating a shunt between your portal vein and your hepatic vein by placing a stent. Here are each of the three parts of the procedure:
- Shunt: Something that re-routes or re-directs flow from its normal pathway.
- Portal vein: The vein that transports blood from your gastrointestinal system, gallbladder, pancreas, and spleen on the way to your liver.
- Hepatic vein: The veins (usually three) that return blood that doesn’t have oxygen from your liver back to your heart.
A specialist known as an interventional radiologist will perform the procedure, typically in a specialized operating suite known as an interventional radiology suite. During this time, an interventional radiologist will use X-ray guidance to place the shunt.
Those who need a TIPS procedure are usually moderately to severely ill.
Examples of conditions and acute occurrences that may warrant a TIPS procedure include:
- Budd-Chiari syndrome: A rare disorder that affects the ability of blood to leave the liver, which causes significant portal hypertension.
- Hepatopulmonary syndrome: A syndrome that occurs in people with significant liver disease that affects the abilities of their lungs to work well.
- Hepatorenal syndrome: A condition where a person experiences significant liver failure that also affects the way their kidneys work.
- Portal hypertensive gastropathy: Bleeding in the stomach and stomach lining due to portal hypertension.
- Refractory ascites: Ascites (severe swelling in the abdomen) that won’t respond to traditional treatments.
- Refractory hepatic hydrothorax: Severe pleural effusion (fluid buildup outside the lungs) that’s a result of significant liver disease.
- Variceal hemorrhage: A condition that causes veins in the esophagus or stomach to bleed profusely.
As you can likely tell from these indications, the liver is an important receiver and transporter of blood in your body. When your liver doesn’t work well, its poor function can impact multiple organ systems and cause symptoms that can become indicators for the TIPS procedure.
Doctors will usually perform a TIPS procedure after other first-line treatments have failed. For example, doctors may try to lower ascites by draining the excess fluid or variceal fluid by banding or stopping bleeding in your esophagus. If these fail, a doctor may recommend a TIPS procedure.
As with any procedure, the TIPS procedure isn’t without side effects. Those who need the procedure are often very sick, which can increase the risk for side effects. A doctor should thoroughly explain the pros, cons, and risks of the procedure.
- It quickly and effectively lowers portal venous pressure.
- It improves renal perfusion, lowers ascites, and can help to reverse hepatorenal syndrome.
- It has a low incidence of postprocedure side effects and 30-day mortality rates.
- People who undergo a TIPS procedure have a 10% higher rate of encephalopathy (brain disturbances that can cause confusion and affected memory) compared with those who don’t undergo the procedure.
- People who undergo a TIPS procedure are at increased risk of right heart failure due to excessive pressures that can back up to the right heart.
Doctors perform the TIPS procedure under general anesthesia (where you’re completely asleep and unaware) or under conscious sedation. While the approaches may vary based on the person, the following are some of the basic steps for a TIPS procedure:
- An interventional radiologist will cannulate (access) your right internal jugular vein.
- The radiologist will advance the catheter down to your right hepatic vein.
- A doctor will use ultrasound guidance to identify your portal veins.
- After identifying the portal veins, the surgeon will place a stent that extends to where your hepatic vein and inferior vena cava meet.
- A doctor may also have to embolize (destroy with heat) other bleeding areas in your body.
- The doctor will measure pressures in the portal veins as well as the right atrium of your heart to ensure the shunt is working appropriately. They’ll also measure the velocity of blood flow via ultrasound to ensure the blood is flowing through the shunt appropriately.
- Your doctor will remove the catheters, and you’ll be taken to the postanesthesia recovery unit, where healthcare professionals will closely observe you.
The TIPS procedure usually takes between 1 and 2 hours.
However, if your case is very complicated, the procedure may take longer.
Some people shouldn’t undergo a TIPS procedure. People who absolutely shouldn’t undergo a TIPS procedure include those with:
- bile duct obstruction
- liver cysts that impair the ability to advance or place a stent
- right heart failure
- sepsis or severe systemic infection
- severe pulmonary hypertension
The fatality rate for a TIPS procedure is less than 1%, and the 30-day mortality rate is less than 3%. This means that after 30 days, 97% of people who underwent the procedure are alive.
The most common causes of death from the TIPS procedure are organ failure and hemobilia, or bleeding within the biliary system.
You’ll likely remain in a hospital for at least 24 hours after a TIPS procedure. This allows medical staff to monitor your blood pressure, heart rate, circulation, and urine output. Your doctor will monitor other blood tests that indicate how well your heart and liver are working and make sure you aren’t experiencing any internal bleeding.
Before you’re allowed to go home, your doctor will perform an ultrasound of your abdomen to identify how well blood is flowing in the portal vein and ensure the stent is working appropriately.
Often, those undergoing a TIPS procedure may be on the list for a liver transplant, which could correct the underlying disorder(s).
The following are some commonly asked questions after a TIPS procedure.
Is there a special diet after a TIPS procedure?
Your doctor may advise you as to a healthy post-TIPS procedure diet. Examples of interventions include a low-protein diet and low-sodium diet. Immediately following the procedure, your doctor may recommend eating no more than 20 grams of protein a day for 3 days to lower the risks for postoperative side effects.
Will I need a liver transplant after a TIPS procedure?
Over time, the TIPS procedure can lower your liver’s functioning. The effect is likely due to less blood flow to your liver. The underlying reasons you needed a TIPS procedure and undergoing the TIPS procedure itself may be indications for a liver transplant. However, there are many factors that impact if you need a liver transplant. You should discuss if you’re a candidate given your age and overall health.
What is the life expectancy after a TIPS procedure in the liver?
A TIPS procedure can lower a person’s mortality compared with no intervention. Those who don’t undergo TIPS procedures but may be candidates have a mortality rate of 40% compared with those who undergo TIPS procedures, whose mortality rate is between 20% and 35%.
A TIPS procedure can lower portal hypertension without requiring significant, open surgery. Because the procedure doesn’t correct the underlying issues of liver dysfunction, you may require further treatments to improve your liver health following the procedure. A doctor should carefully explain the risks and benefits of the procedure to you before undergoing it.