Transjugular intrahepatic portosystemic shunt (patient information)

Description

This is not a surgical procedure. It is done by a radiologist using x-ray. A radiologist is a doctor who uses imaging techniques to diagnose and treat diseases. You will be asked to lie on your back. You will be connected to monitors that will check your heart rate and blood pressure. You will probably receive local anesthesia and medicine to relax you. This will make you pain-free and sleepy. Or, you may have general anesthesia (asleep and pain-free). Then an artificial channel will be created between the veins of the liver.

Why the Procedure is Performed

• Normally, blood coming from your esophagus, stomach, and intestines first flows through the liver. When your liver has a lot of damage and there are blockages, blood cannot flow through it very easily. This is called portal hypertension (increased pressure and backup of the portal vein). The veins can then break open (rupture), causing serious bleeding.
• Common causes of portal hypertension are:
  • Alcohol use causing scarring of the liver (cirrhosis)
  • Blood clots in a vein that flows from the liver to the heart
  • Too much iron in the liver (hemochromatosis)
  • Hepatitis B or hepatitis C
• When portal hypertension occurs, you may have:
  • Bleeding from veins of the stomach, esophagus, or intestines (variceal bleeding)
  • Buildup of fluid in the belly (ascites)
  • Buildup of fluid in the chest (hydrothorax)
• This procedure allows blood to flow better in your liver, stomach, esophagus, and intestines, and then back to your heart.

Prior

• The night before to your procedure, do not eat any food or drink any liquid. However, you may be allowed to drink clear liquids to help you on the day of the TIPS procedure. It is well advised to take your morning medication as instructed by your physician and to stay in the hospital for 24 hrs for observation after the procedure.
• Your doctor may ask you to have these tests:
  • Blood tests (complete blood count, electrolytes, and kidney tests)
  • Chest x-ray or ECG
• Tell your health care provider:
  • If you are or could be pregnant
  • Any medicines you are taking, even drugs, supplements, or herbs you bought without a prescription (your doctor may ask you to stop taking blood thinners like aspirin, heparin, warfarin, or other blood thinners a few days before the procedure)
• DO NOT eat or drink anything after midnight the night before the procedure.
• Ask your doctor which medicines you should still take on the day of the procedure. Take these drugs with a small sip of water.
• Take a shower the night before or the morning of the procedure.
• Arrive on time at the hospital.
• You should plan to stay overnight at the hospital.

During

• The doctor inserts a catheter (a flexible tube) through your skin into a vein in your neck. This vein is called the jugular vein. On the end of the catheter is a tiny balloon and a metal mesh stent (tube).
• Using an x-ray machine, the doctor guides the catheter into a vein in your liver.
• Dye (contrast material) is then injected into the vein so that it can be seen more clearly.
• The balloon is inflated to place the stent. You may feel a little pain when this happens.
• The doctor uses the stent to connect your portal vein to one of your hepatic veins.
• At the end of the procedure, your portal vein pressure is measured to make sure it has gone down.
• The catheter with the balloon is then removed.
• After the procedure, a small bandage is placed over the neck area. There are usually no stitches.
• The procedure takes about 60 to 90 minutes to complete.

After

• After the procedure, you will recover in your hospital room. You will be monitored for bleeding. You will have to keep your head raised.
• There is usually no pain after the procedure.
• You will be able to go home when you feel better. This may be the day after the procedure.
• Many people get back to their everyday activities in 7 to 10 days.
• Your doctor will probably do an ultrasound after the procedure to make sure the stent is working correctly.
• You will be asked to have a repeat ultrasound in a few weeks to make sure that the TIPS procedure is working.

Risks

Possible risks with this procedure are the following:

• Damage to blood vessels
• Fever
• Hepatic encephalopathy (a disorder that affects concentration, mental function, and memory, and may lead to coma)
• Infection, bruising, or bleeding
• Reactions to medicines or the dye
• Stiffness, bruising, or soreness in the neck

Rare risks are:

• Bleeding in the belly
• Blockage in the stent
• Cutting of blood vessels in the liver
• Heart problems or abnormal heart rhythms
• Infection of the stent

Common possible risks	Rare possible risks
Oral glucose tolerance test	An increase in the heart rate by 10 beats per minute or more in the first hour after an oral glucose challenge of 50 grams glucose after fasting for 10 hours.
Mixed-meal tolerance test	Hypoglycemia between 60 to 180 minutes, after a mixed-meal (lipids, carbohydrates, proteins) after fasting for 10 hours.
Hydrogen breath test	A positive hydrogen breath test (a rise of 10 to 15 parts per million) after glucose ingestion.

Outlook (Prognosis)

• Your radiologist can tell you right away how well the procedure worked. Most people recover well.
• TIPS works in about 80% to 90% of portal hypertension cases.
• The procedure is much safer than surgery and does not involve any cutting or stitches.

Goal

This new pathway will allow blood to flow better. It will ease pressure on the veins of your stomach, esophagus, intestines, and liver.

Alternative Names

TIPS; Cirrhosis - TIPS; Liver failure - TIPS