Transjugular Intrahepatic Portosystemic Shunt (TIPS)

What is TIPS?
TIPS stands for Transjugular Intrahepatic Portosystemic Shunt.

What are the reasons for a TIPS Procedure?
The TIPS procedure is performed in patients with portal hypertension (increased pressure in the Portal Vein) causing severe variceal bleeding or to prevent rebleeding. It may also be performed in an emergency when the bleeding can’t be controlled by other means. TIPS also may be used as a treatment to control bleeding when the patient is a candidate for liver transplantation and becomes unstable secondary to bleeding. The TIPS procedure is often a successful alternative to surgery when medical management is no longer effective.  Other indications for TIPS procedure include recurrent abdominal fluid collection (ascites) and Portal Vein clotting (thrombosis).

Who is candidate for TIPS procedure?

This procedure is reserved for patients who have severe liver (hepatic) disease called cirrhosis. The most common causes of liver cirrhosis are alcoholism and viral hepatitis.

Chronic inflammation in the liver results in deposition of stiff fibrous scar tissue which can limit blood flow through the liver from the portal vein. This causes back up of blood and thus increased pressure in the portal venous system. The body responds by diverting this blood through blood vessels surrounding the upper portion of the stomach and the lower portion of the esophagus. The increased blood volume in these veins causes formation of varices (swollen veins with weakened walls), which often rupture under increased pressure - a problem compounded by the fact that patients with liver disease often have deficiencies in blood clotting.  Patients thus may present with rectal bleeding, vomiting of blood or black tarry stools.

How do I prepare for the procedure?

You will be scheduled for a consultation with the Interventional Radiology Team. Bring a list of questions to ask your doctor. It is important that you understand exactly what procedure is planned, the risks, benefits and other options before your procedure.

What happens during the procedure?
Conscious sedation is provided prior to starting and throughout the procedure.

You will lie flat on the x-ray table and will be connected to several types of monitoring equipment. The technologist will prepare the skin over your neck by cleaning it with an antiseptic solution and place sterile drapes and towels over you to create a sterile work space.
Lidocaine local anesthesia is injected into the skin overlying the right internal jugular vein in your neck.   The Interventional Radiologist will access your vein, inject dye and uses X-ray guidance to perform the TIPS.The jugular vein sheath will be removed immediately following the procedure.The procedure length varies from one to three hours. 

What happens after the procedure?
Since conscious sedation medicine was administered you will be required to stay to recover for two to four hours after the end of the procedure. While in recovery, patients are monitored closely for signs of internal bleeding and bleeding from the vein in the neck, and to ensure that the effects of the sedation have worn off.You must have a responsible adult available to drive/escort you home from the hospital. Check your dressing throughout the day for any increased drainage.  Keep the dressing dry for 24 hours and then remove.  If you experience excessive bleeding from the skin site, apply pressure to the site and seek medical attention.

An ultrasound evaluation of the shunt will be performed within 2 weeks after being placed. Ultrasound surveillance is performed on a regular bases to evaluate shunt patency.

What are the potential complications of this procedure?

Please contact your doctor for any of the following conditions:

  • Shunt narrowing or occlusion (blockage). Follow-up ultrasounds are performed frequently after the TIPS procedure to detect these complications. The signs of occlusion include increased ascites or rebleeding. This condition can be treated by a radiologist who re-expands the shunt with a balloon or repeats the procedure to place a new stent.
  • Encephalopathy -- mental changes caused by abnormal functioning of the brain that occur with severe liver disease. Encephalopathy can be worse when blood flow to the liver is reduced by TIPS, which may result in toxic substances reaching the brain without being metabolized first by the liver. This condition can be treated with medications, diet or by revising the shunt. Upon discharge from the procedure, after evaluation from physician, a medication may be prescribed to help prevent this condition.

If you have any questions or need to reschedule an appointment please feel free to contact the Interventional Radiology Office at 802- 847-8359. Our business hours are Monday – Friday 8:30 a.m. to 5 p.m. Someone is available to take your call after hours for emergencies.

This information is provided by the Fletcher Allen Health Care, Department of Radiology, Division of Interventional Radiology and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact your health care provider.