What Are MIIPs? / Transjugular Intrahepatic Portosystemic Shunt (TIPS)
What is the liver?
The liver is an organ in the right upper abdomen. The blood from the digestive organs normally drains into the liver through a blood vessel called the portal vein. The digestive organs include the esophagus, stomach, spleen, and intestines. This blood is rich in nutrients and waste from the food we eat. The liver uses nutrients from food to make energy. The liver also cleans the waste out of the blood.
What is a Transjugular Intrahepatic Portosystemic Shunt (TIPS)?
A TIPS is a connection made between two veins inside the liver: a liver vein and the portal vein. A TIPS allows some of the blood from the portal vein to bypass the liver.
An interventional radiologist (IR) makes this connection by placing a woven metallic tube called a stent between the two veins.
Who may need a TIPS?
You might need a TIPS if you have symptoms related to high blood pressure in your liver. High blood pressure in the liver is called portal hypertension. Medicines can usually treat the symptoms related to portal hypertension. For some people, though, medicines are not enough. A TIPS relieves the high blood pressure in the liver by decreasing the amount of blood that flows to the liver.
What are the symptoms of portal hypertension?
Portal hypertension, or high blood pressure in the liver, causes blood to back up into the veins of the digestive organs that drain into the portal vein. The high back pressure in those veins can cause them to enlarge, weaken and bleed. These abnormal veins are called varices. If the varices bleed, it can cause a patient to vomit blood or bleed inside the body. This can be life-threatening.
High blood pressure in the liver can also cause a buildup of fluid in the abdomen (called ascites) or the chest (called an effusion). This fluid can be uncomfortable or make it hard to breathe. The procedure to remove ascites is called a paracentesis. The procedure to remove an effusion is called a thoracentesis. For some people, the fluid keeps building up and they need many repeated procedures to remove it. A TIPS can decrease the amount of ascites or effusion that builds up.
In summary, you may need a TIPS if you have high blood pressure in your liver and
Life-threatening bleeding from abnormal veins called varices
Excess fluid in your belly requiring repeated procedures to remove it
Excess fluid in your chest requiring repeated procedures to remove it
Who places the TIPS and where is it performed?
A TIPS is performed by an interventional radiologist (IR), a doctor that specializes in minimally invasive, image- guided procedures (MIIPs). The TIPS procedure is done in a special room using low dose x-rays.
How do I prepare for a TIPS?
What can I expect?
You will change into a hospital gown
A small IV will be placed into a vein in your arm.
You will lay flat on a procedure table in a special room with a moving x-ray machine.
A TIPS is usually performed under general anesthesia, meaning you will be asleep with a breathing tube. If so, you will meet the anesthesia team.
The anesthesiologist will give you medicines to put you to sleep.
Your skin will be cleaned and prepared. The entire procedure is done through veins, which the IR reaches through one or two tiny holes in your neck or groin.
The procedure usually takes 2-3 hours but can take longer, depending on how complex it is.
At the end of your procedure, the IR will place a small bandage on your skin. No stitches are needed.
You will stay the night to watch for complications. Most patients go home the next day.
What will happen during the procedure?
The IR places a small needle into the large neck vein, using ultrasound to see the vein.
The IR threads a wire through this needle then removes the needle, leaving the wire.
The IR puts a small, straw-like tube called a catheter over the wire to get into the largest vein in the body, the vena cava.
Low dose moving x-rays and contrast dye help the IR guide the catheter into a liver vein and make a connection to the portal vein.
After making the connection between the two veins, the IR places the woven metal tube or stent to keep the connection open.
What are the risks or complications of the procedure?
Minor bleeding at the neck or liver
Severe bleeding at the neck or liver, requiring blood transfusions or another procedure
Damage to the blood vessels or surrounding tissues
Allergic reaction to the contrast dye and other medicines
Confusion, also called encephalopathy - This can usually be controlled with medicines or by making the TIPS smaller.
What can I expect after a TIPS?
Your doctor will examine you and monitor your symptoms regularly. You will have regular ultrasounds to to check your TIPS to make sure it is open and working properly.
A TIPS is successful at relieving the symptoms of bleeding from varices in more than 9 out of 10 patients. Around 8 out of 10 patients with abnormal build up of fluid in their belly will get relief after having a TIPS. The success rate is a little lower in patients with abnormal build up of fluid in their chest.
Sometimes the symptoms of high blood pressure in the liver do not get better after a TIPS. When this happens, the TIPS can be made bigger to let more blood bypass the liver. Over time, the TIPS may become narrowed or blocked. When this happens, the IR can open up the TIPS with a small balloon.
For more information on TIPS: