Transjugular Intrahepatic Portosystemic Shunt (TIPS)
A minimally invasive treatment to reduce bleeding risk or excess fluid
What is a TIPS and why do I need one?
Blood from the organs in your belly flows through your liver, which filters out the nutrients and toxins. Long-term liver damage can cause scarring and stiffening, which is called cirrhosis. Cirrhosis makes it harder for blood to flow, so pressure builds in nearby veins. When this stretches them out, these veins are called varices. Varices are fragile and can bleed easily. This can be life-threatening.
Cirrhosis can cause fluid to build up around the organs of the belly. This fluid, called ascites, can be uncomfortable. It make it hard to take deep breaths.
Transjugular intrahepatic portosystemic shunt, or TIPS, is a treatment for severe varices or ascites that keeps coming back. It is a tunnel made between two veins in the liver to allow some of the blood to bypass the liver. This relieves the back pressure in the varices so they are less likely to bleed. The ascites goes down too.
How is a TIPS placed?
Your clinician will perform your TIPS through a pinhole in your neck. You will receive medicines to go to sleep during the procedure. The skin of your neck will be cleaned, and the clinician will thread small tools into a large vein in your neck. Sometimes the clinician will also go through a vein at the top of your thigh to pass a tiny ultrasound to see inside you.
They will then use moving x-rays and ultrasound to guide tiny tools through your liver. They will create a bypass between two veins in your liver by placing a metallic mesh tube called a stent. Your clinician will make sure the pressure to your liver goes down after the stent is in place. Sometimes the clinician will plug up the varices to make sure they will not bleed. At the end of the TIPS, your clinician will place a bandage on your neck.
Transjugular Intrahepatic Portosystemic Shunt
1. The clinician threads a thin tube into the vein of the neck and into the liver. They use tiny tools to pass the tube from one vein into the other.
2. They first make a tunnel between two veins in the liver to create a bypass for some of the blood.
3. Then they put a stent in the tunnel to keep it open. After, they apply a bandage.
What are the risks?
TIPS is a generally a safe procedure when performed by a specialist.
Minor complications occur in 4 in 100 people. These include minor bleeding, temporary kidney injury, or fever.
Major complications occur in 3 in 100 people. Confusion can worsen after TIPS. Usually this can be managed with medicines. Rarely another procedure is needed to adjust the TIPS. Other major complications include serious bleeding, damage to surrounding organs, heart failure, kidney failure, or liver failure. There is also a risk of death after TIPS. Clinicians can estimate this risk for an individual depending on their health.
What are the alternatives?
For severe varices / bleeding risk
Alternative 1 Not doing procedure at all. The advantage is avoiding a procedure and its risks. The disadvantage is that your symptoms could become worse and life-threatening.
Alternative 2 Medicines to decrease the risk of future bleeding. They do not stop bleeding that is already happening. The risk of bleeding again is higher with medicines alone as compared to TIPS.
Alternative 3 Endoscopy. A clinician passes a camera down your throat to see the bleeding varices. They can inject medicine in them or put bands around them. This option is less invasive than TIPS but the risk of bleeding again is higher.
For severe ascites / fluid build up
Alternative 1 Not doing procedure at all. The advantage of this is avoiding a procedure and its risks. The disadvantage is that the ascites will keep building up.
Alternative 2 Paracentesis. A small tube is put in the belly to drain the ascites. The fluid will build up again and has to be drained with repeated paracentesis.