TIPS Procedure (Transjugular Intrahepatic Portosystemic Shunt)

What is a TIPS procedure?

TIPS stands for transhepatic intrajugular portosystemic shunt. You may need a TIPS procedure if you have portal hypertension from severe liver disease.

In portal hypertension, something blocks or slows down the flow of blood through your portal vein. This puts pressure on the vein, so it expands. Your body tries to fix the issue by sending blood into other smaller veins. The extra blood flowing through smaller veins weakens them, so they may burst and leak blood into your throat.

A TIPS procedure involves placing a stent that connects your portal vein to a hepatic vein. This is a vein in your liver. The stent lets blood flow from your portal vein to a hepatic vein, which moves blood away from your liver.

Who qualifies for a TIPS procedure?

This procedure may help people who have conditions like:

• Ascites: This is fluid buildup in your abdomen (belly).
• Budd-Chiari syndrome: This condition affects your hepatic veins, so blood backs up into your liver and spleen.
• Hepatic hydrothorax: Cirrhosis may cause water to build up in your chest.
• Hepatopulmonary syndrome: Severe liver disease affects blood vessels in your lungs, so you have low levels of oxygen.
• Hepatorenal syndrome: This is kidney failure that liver disease may cause.
• Swollen veins: You may have swollen veins in your esophagus (esophageal varices) and stomach (gastric varices).

How should I prepare for a TIPS procedure?

Your healthcare team will explain what you should do before the procedure. In general, you should:

• Plan to remain in the hospital overnight for one or more days after your procedure
• Tell your radiologist what medications you take, including over-the-counter medications and herbal supplements (a radiologist is a healthcare provider who uses imaging technology to diagnose and treat disease)
• Tell them about any allergies, including latex allergies or allergic reactions to anesthesia

You may have certain tests before the procedure, including liver function and kidney function tests. You may have a blood test to check how long it takes for your body to make a blood clot. You may also have imaging tests like a computed tomography (CT) scan.

Your radiologist will explain what you need to do to get ready for treatment. For example, they may tell you to stop eating or drinking at least eight hours before the procedure.

Your anesthesiologist will discuss the type of anesthesia you’ll receive. That may be general anesthesia, so you’re asleep during the procedure, or sedation, so you’re semi-awake. You may feel very drowsy but not have pain.

What happens during a TIPS procedure?

When you arrive at the hospital, a healthcare provider will give you a gown to wear during the procedure.

First, you’ll lie down on a procedure table. Your anesthesiologist will give you anesthesia.

The procedure itself involves the following steps. Your radiologist will:

1. Make a tiny cut in your neck so they can place a catheter into your right interior jugular vein
2. Move the catheter down to a hepatic vein on the right side of your liver
3. Use ultrasound to locate your portal vein
4. Place the stent so it reaches from your portal vein to your hepatic vein
5. Check the stent to be sure it’s diverting blood from your portal vein to your hepatic vein
6. Remove the catheter

TIPS procedures typically take one to two hours. Your team will move you to a recovery room after the procedure. They’ll check on you as you wake up from anesthesia.

What happens after a TIPS procedure?

While you’re still in the hospital, your care team will watch for side effects like bleeding or infection. Your radiologist may do follow-up imaging tests to confirm that the stent works.

What are the benefits of a TIPS procedure?

A TIPS procedure reroutes blood in your liver. It can:

• Relieve pressure on veins in your liver
• Stop internal bleeding and fluid backup

How successful are TIPS procedures?

Research shows TIPS are successful. For example, a 2022 review of TIPS procedures concluded that 95% of the procedures were successful.

Complications of TIPS procedures

TIPS may cause the following complications:

• Hemobilia: This is bleeding from and/or into your liver ducts.
• Hemoperitoneum: The procedure may cause bleeding in your peritoneal cavity, the space that contains abdominal and pelvic organs.
• Hepatic encephalopathy: This happens because your liver doesn’t filter toxins like it should. These toxins build up in your blood and affect your brain.
• Liver failure: The procedure may affect your liver’s ability to work well enough to meet your body’s needs. This happens in patients with advanced liver disease.
• Organ failure: TIPS affects one or more of your organs’ abilities to work as they should.

What is the recovery time?

Most people remain in the hospital for one to two days. Once at home, you should:

• Rest: Extra rest will help your body recover from surgery.
• Drink up: Drinking at least eight glasses of water every day will help your body get rid of fluid buildup from ascites.
• Avoid strenuous activity: Take it easy for at least 10 days after your procedure. That includes lifting anything that weighs more than 10 pounds.
• Be patient: TIPS procedures take time to work. For example, it can take weeks or months for fluid buildup from ascites to go away.

What’s the life expectancy after a TIPS procedure?

This procedure relieves high blood pressure in your portal vein. But it doesn’t treat the underlying liver disease. Many factors affect life expectancy with liver disease. Everyone’s situation is a bit different. If you have questions about what to expect after a TIPS procedure, ask your radiologist to explain how the procedure may affect how long you live.

When should I call my healthcare provider?

You should contact your healthcare provider or go to the emergency room if you have symptoms like:

• Severe confusion
• Drowsiness
• Involuntary movements like facial twitches

These are hepatic encephalopathy symptoms. This is a life-threatening complication of a TIPS procedure.