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TIPS (Transjugular Intrahepatic Portosystemic Shunt)

Talk with your health care provider about the risks and possible complications of the TIPS procedure.

A healthy liver does many important jobs. It processes alcohol, food, and medicines. It makes digestive juices, helps with blood clotting, and helps your body fight infection. The portal vein is the large vessel that carries most of the blood from the intestine to the liver. Certain diseases or a blockage in the portal vein can cause blood pressure to rise in this vein. This often leads to fluid buildup in the abdomen (ascites) and massive bleeding. The TIPS procedure helps ease the pressure in the portal vein. The procedure is done by a specially trained doctor called an interventional radiologist.

Although the TIPS procedure can lower portal pressure, it may make liver failure worse in people with severe liver disease. Encephalopathy can happen if too much blood bypasses the liver after a TIPS. Encephalopathy comes from toxins in the bloodstream that are normally filtered by the liver. Encephalopathy can be treated by having the stent in the bypass revised or completely blocking it off.

Liver showing stent connecting portal vein and hepatic vein.

How to get ready for the procedure

Follow any instructions you are given to get ready, including:

  • Follow any directions you’re given for not eating or drinking before the procedure.

  • Tell the technologist what medicines, herbs, or supplements you take. Also tell the technologist if you are or may be pregnant, or if you are allergic to contrast medium (x-ray dye) or other medicines.

During the procedure

TIPS is a complex procedure. Your health care provider can explain it to you. Below is a summary of what will happen during the procedure.

  • You will be under general anesthesia or conscious sedation. You will have an IV (intravenous) line to give you fluid and medicines. You will also be given medicine through the IV to help you relax.

  • Local anesthesia is injected to numb the skin at the incision site. A very small cut (incision) is made on the right side of your neck. A needle with a guide wire attached is put through the incision into a vein.

  • Contrast medium is injected into the vein. This helps the vein show clearly on X-ray images. Using these images as a guide, the radiologist moves the needle into another large vein in the liver (hepatic vein).

  • The needle is pushed through the wall of the hepatic vein into the portal vein. A thin flexible tube (catheter) is threaded over the guide wire. A metal mesh cylinder (stent) is moved through the catheter and placed over the needle between the hepatic and portal veins. The stent creates a passageway (shunt) between the 2 veins. Blood flows freely through the shunt into the hepatic vein, relieving the high pressure in the portal vein.

  • When the procedure is finished, the needle, wire, and catheter are taken out. The stent stays in place to hold the shunt open.

After the procedure

  • Your blood pressure and pulse will be watched closely for several hours after the procedure.

  • You will not be able to eat or drink for several hours after the procedure.

  • The catheter in your neck may stay in place for a day or longer.

  • You may have 1 or more ultrasound tests to check how well the shunt is working.

  • You will stay in the facility or hospital overnight for observation.

Online Medical Reviewer: MMI board-certified, academically affiliated clinician
Online Medical Reviewer: Pierce-Smith, Daphne, RN, MSN, CCRC
Online Medical Reviewer: Turley, Ray, BSN, MSN
Last Review Date: 4/25/2014
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