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Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure to create new connections between two blood vessels in your liver. You may need this procedure if you have severe liver problems.
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).
Your radiologist will insert a catheter (a flexible tube) through your skin into a vein in your neck.
This new pathway will allow blood to flow better. It will ease pressure on the veins of your stomach, esophagus, intestines, and liver.
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:
When portal hypertension occurs, you may have:
This procedure allows your blood to flow better in your liver, stomach, esophagus, and intestines, and then back to your heart.
Possible risks with this procedure are:
Rare risks are:
Your doctor may ask you to have these tests:
Always tell your doctor or nurse:
On the day of your procedure:
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.
Your radiologist can tell you right away how well the procedure worked. Most patients recover well.
TIPS works in about 80% - 90% of portal hypertension cases.
The procedure is much safer than surgery and does not involve any cutting or stitches.
Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 156.
Shah VH, Kamath PS. Portal hypertension and gastrointestinal bleeding. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier;2010: chap 90.
Sicklick JK, D'Angelica M, Fong Y. The liver. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 54.