Transjugular Intrahepatic Portosystemic Shunt (TIPS)

A Transjugular Intrahepatic Portosystemic Shunt (TIPS) is a small, tubular metal device commonly called a stent that is placed in veins in the middle of the liver to permit blood flow to bypass the liver. In a TIPS procedure, interventional radiologists use image guidance to make a tunnel through the liver to connect the portal vein (the vein that carries blood from the digestive organs to the liver) to one of the hepatic veins (three veins that carry blood away from the liver back to the heart). A stent is then placed in this tunnel to keep the pathway open.

Your doctor may recommend a TIPS procedure to treat the complications of portal hypertension, including:

• Variceal bleeding, bleeding from any of the veins that normally drain the stomach, esophagus or intestines into the liver.
• Portal gastropathy, an engorgement of the veins in the wall of the stomach, which can cause severe bleeding.
• Severe ascites (the accumulation of fluid in the abdomen) and/or hydrothorax (in the chest).
• Budd-Chiari syndrome, a blockage in one or more veins that carry blood from the liver back to the heart.

You may be instructed not to eat or drink anything after midnight before your procedure. Your doctor will tell you which medications you may take in the morning. You may be allowed to drink clear liquids on the day of your procedure. You should plan to stay overnight at the hospital for one or more days. You will be given a gown to wear during the procedure.

In this procedure, x-ray or ultrasound equipment is used for guidance, and a stent and a balloon-tipped catheter are used for repair. A catheter is a long, thin plastic tube, about as thick as a strand of spaghetti. The stent used in this procedure is a small wire mesh tube, often covered with a fabric made of GORE-TEX®.

A TIPS procedure reroutes blood flow in the liver and reduces unusually high blood pressure in the veins of the stomach, esophagus, bowel and liver, as well as bleeding from enlarged veins across the esophagus and stomach. A TIPS procedure involves generating a pathway through the liver that connects the portal vein (this vein carries blood from the digestive organs to the liver) to a hepatic vein (one of three veins that carry blood from the liver to the heart). A stent placed inside this pathway keeps it open and in turn reduces high blood pressure in the portal vein and bleeding from enlarged veins.