This is an abbreviated version of the complete article.*
Liver disease can cause scar tissue to form in the liver, disrupting the normal flow of blood through the organ and preventing the liver from filtering blood effectively.
To improve blood flow through the liver, physicians perform a procedure called a transjugular intrahepatic portosystemic shunt, or TIPS.
TIPS creates a new route for blood to flow through the liver and into the major veins that lead back to the heart, reducing back pressure in the veins that flow into the liver.
When the liver is affected by disease, it can have harmful consequences throughout the body because toxins accumulate in the blood and the immune system is disrupted. Some types of liver disease cause cirrhosis, which causes the formation of scar tissue in the liver that disrupts blood flow through the organ. The scar tissue prevents the liver from filtering blood and may cause portal hypertension (increased blood pressure in the portal vein that leads to the liver). Both hypertension and scar tissue prevent blood from flowing freely into the liver. This can cause blood to back up into the portal vein branches that flow away from the liver. This diversion of blood raises the blood pressure inside these veins, and the increased pressure may in turn cause varices, which are abnormally enlarged and twisted veins.
To treat portal hypertension and varices, physicians use a procedure called transjugular intrahepatic portosystemic shunt (TIPS). This treatment creates a bypass for blood to flow through a damaged liver and into the major veins that lead back to the heart, reducing the pressure in the veins that flow into the liver and minimizing fluid build up.
WHEN IS TIPS INDICATED?
TIPS may be indicated for persons with:
Variceal hemorrhage, or
To identify liver disorders, physicians will take a careful medical history and perform tests, which may include:
Liver biopsy; and/or
WHAT TO EXPECT
TIPS is a minimally invasive procedure, and because there are no nerve endings in the vein, it is usually painless. During the TIPS procedure, an intravenous line is placed in the patient's arm to administer medications. The patient is connected to monitors that track heart rate, blood pressure, and pulse during the procedure. The skin on the neck is cleaned and the insertion point is numbed with a local anesthetic. Using ultrasound images of the neck, a physician makes a needle puncture in the skin and guides the needle into the jugular vein. Through the incision, a guidewire is inserted in the vein. A short hollow tube (catheter sheath) is then guided over the wire, and then a hollow guide catheter is inserted through the sheath.
The physician uses fluoroscopy, a type of X-ray that projects images onto a screen, to monitor the guidewire and catheter's location. The catheter is then guided through the jugular vein to the vena cava and into the hepatic vein within the liver.
A catheter with a small cutting needle is inserted through the guide catheter and into the liver. Once inside a hepatic vein, the needle is exposed and advanced into and through the liver tissue. The physician monitors the screens until the needle makes contact with and enters a branch of the portal vein, creating a narrow pathway between two veins. The physician removes the needle, inserts a balloon-carrying catheter to the site of the pathway made by the needle, and inflates the balloon in order to dilate, or open wide, the shunt, or bypass. Once the shunt is open wide, the physician inserts another catheter to place a stent, or expandable metal tube, inside the shunt. The stent helps keep the shunt widely open and allows blood to flow through the bypass between the blood vessels.
The procedure takes between one and three hours.
Following the TIPS procedure, the patient is not allowed to eat or drink for several hours; fluid and nutrients may be administered intravenously. The patient may remain in the hospital for two to three days following the procedure, and the physician will monitor blood pressure and abdominal ultrasounds regularly to assess the performance of the shunt.
Ten days following the procedure, the patient will undergo blood tests to assess liver function. At six weeks, the patient will again undergo blood tests and an abdominal ultrasound or venography; a similar follow up may be conducted at 12 months.
The patient may be placed on a diet that is low in both salt and protein, and a laxative (lactulose) may be prescribed to soften the stool and help minimize the accumulation of blood toxins that may affect brain function.
TIPS rarely causes serious complications. Some possible complications may include:
Bruising on the neck near the insertion point;
Stenosis (the narrowing of the shunt passageway);
Occlusion (the formation of complete blockage inside the stent); or
Encephalopathy (the presence of blood toxins).
More serious complications, reported in fewer than five percent of all TIPS cases, may include:
Hepatic artery puncture;
Abdominal bleeding; or
Death (extremely rare).
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