TIPS (Transjugular Intrahepatic Portosystemic Shunt)

TIPS is a procedure that lowers pressure in the portal vein. That’s the vein that moves blood to your liver. The medical name for it is transjugular intrahepatic portosystemic shunt. Most people just call it TIPS.

When pressure in the portal vein gets too high (called portal hypertension), it can back up and make the veins around your stomach and esophagus, or food pipe, swell. These swollen veins are called varices. If they swell too much, they break open and bleed. This is called variceal bleeding. High pressure can also cause fluid to leak out and build up in your belly (ascites) or around your lungs (pleural effusion).

Doctors might use a TIPS procedure to treat variceal bleeding, ascites, or pleural effusion, when other treatments aren’t working.

The Procedure

Before the procedure, you’ll get a general anesthetic that puts you to sleep. The doctor will insert a thin, flexible tube, called a catheter, into a blood vessel in your neck. They’ll use an imaging test, usually an x-ray with contrast dye, to guide the catheter until it gets to your liver. Then the doctor will create a channel from the hepatic vein (the vein that takes blood out of the liver), to the portal vein. This channel allows blood to bypass your liver.

The TIPS stent, which is a wire mesh tube, will be placed to keep the channel open. Then, the doctor can measure the blood flow in your veins to make sure the pressure drops. If it’s still too high, they might use a balloon on the catheter to open the stent wider. The procedure usually takes 2 to 4 hours.

After the Procedure

After the procedure, you’ll stay in the hospital, but most people can go home after a day or 2. It can take weeks or months for the TIPS to work. So if you have fluid build-up in (ascites or pleural effusion), it may take time for the fluid to go away.

After you go home, rest and drink lots of water. For at least 10 days, don’t do heavy exercise (like running), and don’t lift more than 10lbs (4.5 kg). You can still do gentle activity, like walking, each day.

It’s really important to watch for symptoms like memory trouble, feeling sleepy, and balance problems. Also watch for yellow skin and swollen legs. Call your doctor or nurse right away if you have any of these symptoms.

You’ll need to have follow-up tests to help your healthcare team check your progress. The TIPS stent can get narrower over time. If this happens, you may need another procedure to make it wider.

Risks and Side Effects

A TIPS procedure can help you feel better and lower your chances of complications from varices, ascites and pleural effusion. But just like any procedure, there are risks and side effects you should know about. You’ll do tests before the procedure to check your risk of side effects.

Because it’s the liver’s job to filter toxins out of your blood, sending some blood through the TIPS means less of it goes through the liver to get filtered. This can cause toxins to build up in your body. Toxin buildup is called hepatic encephalopathy. It can cause you to feel confused, have balance problems, and feel sleepy. About 3 out of 10 people will get hepatic encephalopathy after a TIPS. It can usually be treated with medicine.

Some people might have more liver problems because less blood goes to the liver. Or they might have heart problems because more blood flows into the heart through the TIPS. If you get major problems that can’t be managed with medicine, your doctor may block off the TIPS stent.

Other side effects are rare. This procedure could cause bleeding, infection, or damage to your kidneys or lungs

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
  2. Canadian Liver Foundation
Last reviewed March 15, 2021
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