What You Need to Know about the Transjugular Intrahepatic Portosystemic Shunt (TIPS)

What is the transjugular intrahepatic portosystemic shunt procedure?
The transjugular intrahepatic portosystemic shunt (TIPS) is a radiologic procedure in which a stent (a tubular device) is placed in the middle of the liver to reroute the blood flow.

During the procedure, a radiologist makes a tunnel through the liver with a needle, connecting the portal vein (the vein that carries blood from the digestive organs to the liver) to one of the hepatic veins (the three veins that carry blood from the liver). A metal stent is placed in this tunnel to keep the track open.

The TIPS procedure is not a surgical procedure - the radiologist performs the procedure within the vessels in the X-ray room under X-ray guidance. Figures 1 and 2 below illustrate the TIPS procedure.

Why do I need to have the TIPS procedure?
Diagnostic tests confirm that you have portal hypertension. Portal hypertension is a condition characterized by increased pressure in the portal vein. The increase in pressure is caused by a blockage in the blood flow throughout the liver.

The TIPS procedure is used to manage the complications of portal hypertension, including:

The TIPS procedure reroutes blood flow in the liver and reduces pressure in all abnormal veins, not only in the stomach and esophagus, but also in the bowel and the liver

What tests are required before the procedure?
Before the TIPS procedure, you will have had the following tests to determine the extent and severity of your portal hypertension:

Before the TIPS procedure You will meet with the interventional radiologist to discuss the steps of the procedure. They will be available to answer any questions you may have.

Before the procedure, please follow these guidelines:

Eating and drinking

fig 1: Portal hypertension before the TIPS procedure is performed.

Portal hypertension causes blood flow to be forced backward, causing veins to enlarge and varices to develop across the esophagus and stomach from the pressure in the portal vein. The backup of pressure also causes the spleen to become enlarged.

fig 2: After the TIPS procedure is performed.

A radiologist makes a tunnel through the liver with a needle, connecting the portal vein (the vein that carries blood from the digestive organs to the liver) to one of the hepatic veins (the three veins that carry blood from the liver). A metal stent is placed in this tunnel to keep the track open.

The shunt allows the blood to flow normally through the liver to the hepatic vein. This reduces portal hypertension, and allows the veins to shrink to normal size, helping to stop variceal bleeding.

Medications

On the day of the procedure

Note to families
Family members and friends are invited to wait for you in the Family Waiting Lounge. This waiting area has a play room for small children, a television, reading materials and comfortable chairs.

Because waiting times can be long, visitors are encouraged to come and go as necessary. The Clinic has several cafeterias and restaurants, a gift shop, and a Health Information Library that may be of interest. We ask visitors to sign in and out of the waiting area so we can find them if necessary.

After the TIPS procedure

What are the potential complications of this procedure? Follow-up medical care will be done in the TIPS clinic What do I need to do to maintain my health after the procedure? For more information
If you have any questions about the TIPS procedure, please call the Section of Hepatology in the Department of Gastroenterology at 216.444.6536.

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This information is provided by the Cleveland Clinic 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 the Center for Consumer Health Information at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771. If you prefer, you may visit www.clevelandclinic.org/health/ or www.clevelandclinicflorida.org. This document was last reviewed on: 11/15/2005

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