TIPS is a technique for decompressing elevated portal vein pressures (portal hypertension) in patients with liver cirrhosis. Portal hypertension can be caused by a number of liver diseases such as hepatitis or alcoholic cirrhosis.
Blood is carried from the bowel and spleen in the portal vein to the liver, where the blood is purified. Cirrhosis blocks small branches of the portal vein within the liver, causing elevation of portal vein pressures. This results in either the formation of ascites and/or varices. Ascites is the accumulation of abnormal fluid within the abdomen. It is caused by leakage of plasma through the portal vein walls. Extensive ascites can be painful and debilitating. Varices are normally small veins which have become massively dilated due to increased pressure within the portal vein. These veins line the bowel wall and can rupture and bleed if they are large enough. This typically occurs in the esophagus and stomach.
A TIPS decreases portal vein pressure by creating a channel from the portal vein to a vein draining the liver (hepatic vein) allowing blood to flow out of the portal vein and, thus, decreasing portal pressure. In a high percentage of patients this decreases the ascites and eliminates the varices.
How is a TIPS performed?
The procedure is performed in the Radiology Department with fluoroscopy by an Interventional Radiologist. It typically takes 1 to 2 hours to perform the procedure. The patient is heavily sedated. As a result the procedure is typically pain free. A catheter is inserted into the jugular vein in the neck through a nick in the skin and advanced into a hepatic vein in the liver. This vein is punctured through the catheter and the portal vein entered. The tract is then dilated and a metal mesh tube (stent) is placed, connecting the two veins.
Are there are alternatives?
Surgery is uncommonly used to create a portal vein shunt. Your doctor will discuss which option is best for you.
How do I prepare for the procedure?
Do not eat or drink after midnight the night before the procedure. Most medications may be taken the morning of the procedure. If you are diabetic, special instructions will be given to you concerning your medications. If you are allergic to x-ray dye (contrast) or iodine, let your doctor know as soon as possible so special preprocedure medications can be given.
What happens after the TIPS?
You will return to your room. Your doctor will tell you when you can eat and how long you need to stay in bed. Your neck and/or abdomen may be sore. Your TIPS will require periodic ultrasound checkups to assure the shunt is working, usually performed every 3 to 6 months.
