Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure to treat complications of severe liver disease. Such complications include bleeding from the esophagus or stomach and the accumulation of fluid in the abdomen. The cause of these complications is high pressure in blood vessels of the liver called portal veins.
The procedure involves inserting a stent (tube) to connect the portal veins to adjacent blood vessels that have lower pressure. This relieves the pressure of blood flowing through the diseased liver and can help stop bleeding and fluid back up.
The procedure is typically performed by radiologists. Many patients receive a local anesthesia to numb a small area of the skin plus sedative and pain medications. In certain cases, general anesthesia may be used, where the patient goes to sleep.
A needle is initially placed in the jugular vein in the right side of the neck to make a small hole. Needles and long, thin tubes called catheters can then be advanced down to the veins in the liver.
A needle is inserted to make a connection between an adjacent vein and a branch of the portal vein. This channel is then expanded, and a tube called a stent is inserted to allow blood to flow more easily through the liver. This tube is left in place.
This procedure is used to treat complications of severe liver disease, when the patient has not responded to less invasive treatments (such as salt restriction in the diet and medications called diuretics to remove fluid).
At the time of the procedure, the risks include:
- A reaction to the anesthesia
- Bleeding into the abdomen
- Cardiac arrhythmia (irregular heart beat)
Because people with severe liver disease are also at risk for encephalopathy (deterioration of brain function), this is another common complication after the TIPS has been inserted and it may require treatment. A patient who has had significant encephalopathy may not be a good candidate for TIPS.
Blockage of the TIPS occurs in most patients within the first year of placement of the TIPS. This may lead to recurrent bleeding or reaccumulation of fluid. If this occurs, the TIPS can be expanded, or a new TIPS may be created.
Death has been reported after TIPS placement. The risk is associated with the complications listed above at the time of the procedure. In addition, deaths have been reported due to worsening liver failure that occurs in the days and weeks after TIPS placement. Patients with more advanced liver disease are at greater risk for worsening liver failure after TIPS placement.
Expectations after surgery
The patient is typically monitored after the procedure, as he or she wakes up from the anesthesia. An ultrasound is commonly performed the morning after the procedure to document that the TIPS is open and functioning well.
The main goal during the recovery period is to watch for signs of complications. Anesthesia helps prevent pain at the time of the procedure, and there is often little, if any, discomfort after the procedure.
by Dave R. Roger, M.D.
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