TIPS Procedure

What is TIPS procedure?

TIPS is a short form for a procedure that helps correct blood flow problems in the liver. Its full name is: Trans-jugular Intrahepatic Porto systemic Shunting.

Who needs TIPS procedure?

TIPS procedure is designed to manage the symptoms associated with serious liver disease. These symptoms may include excessive water accumulating in the abdomen or chest that is not responding to medication. It is also indicated for patients at-risk or those who already have had severe hemorrhage from the food pipe due to liver disease, especially in those in whom other forms of treatment like medication and endoscopy has not been effective. It is also done in some specific types of severe liver disease such as Budd-Chiari syndrome.

How is the procedure performed?

The procedure is done under deep sedation without any incisions from the neck blood vessel. It involves creating a new channel between blood vessels supplying the diseased liver and into main blood vessels that lead blood flow back to the heart. It involves placing a special stent within the liver to bypass the blood flow.

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How does TIPS help a person with liver disease?

Most of the blood flowing through the liver comes from portal vein. Portal hypertension occurs when there is reduced blood flow through the liver and there is a large difference in the pressure between the blood entering the liver and exiting the liver to return to the heart. A common cause of portal hypertension is cirrhosis of the liver. With cirrhosis, the normal liver cells are damaged and replaced by scar tissue. When blood tries to pass through the liver, it meets resistance due to scarring, and must find another channel. The body diverts this flow through vessels surrounding the stomach and lower portion of oesophagus. This increased blood flow causes these veins to swell up called varices. These varices can burst and cause life threatening bleeding. Fluid called ascites can also accumulate in the abdomen due to poor liver circulation.

TIPS procedure helps to bypass this flow leading to reduction in risk of bleeding and relief of symptoms.

 

What is portal hypertension?

The liver is the largest organ in the body, weighing about 3 pounds, and is responsible for over 500 functions. Most of the blood that leaves the stomach and the small intestines must pass through the liver. A serious problem that occurs when the blood flow through the liver is decreased in any way is called portal hypertension.

 

How long is the procedure?

A TIPS procedure has a success rate of 95%, and takes from 90 min to up to 3 hours to perform.

 

What are the risks of the procedure?

These include bleeding, confusion or disorientation called encephalopathy (usually temporary and can be treated with medications or by revising the shunt), infection, accelerated liver dysfunction, abnormal heart rhythm. Most of the complications are manageable and can be controlled. The risk varies from person to person, and are discussed during pre-procedure evaluation.

 

What to expect after TIPS procedure?

Typical hospital stay is 1-3 days after the procedure. Up to 1 in 3 persons who have TIPS have encephalopathy or mental confusion. This can be treated with diet, medication or by revising the shunt. Patients are also placed on follow-up ultrasounds to check stent patency, as there is always a small chance of stent getting narrowed or blocked, which can be fixed.