TIPS Shunt
What is TIPS?
TIPS is a short name for Transjugular Intrahepatic Portosystemic Shunt (TIPS). TIPS is a procedure used to manage portal hypertension and some of its complications. Complications of portal hypertension include: bleeding from esophageal or gastric varices, ascites (fluid accumulation in the abdominal cavity) and hydrothorax (fluid accumulation in the chest).
The TIPS procedure involves inserting a metal mesh stent into the liver to connect the portal and hepatic veins (see figure). This connection lowers the portal vein pressure, decreases the risk of variceal bleeding, and assists in the control of ascites/hydrothorax. A TIPS may be performed in the following situations:
• When medicines or endoscopic band ligation are unable to control variceal bleeding;
• When medications such as diuretics (i.e. Aldactone, Lasix, etc.) are unable to control ascites, resulting in the need for frequent abdominal taps of the belly to remove fluid directly.
Why do I need a TIPS?
Your liver, located in the upper right portion of your abdomen, performs hundreds of functions. These functions include removing toxins such as drugs and alcohol from your body, and helping produce other substances that help your blood clot if you start to bleed.
Normally, blood flows to the liver from the portal vein and exits via the hepatic veins, eventually emptying into the inferior vena cava that flows back to the heart. With end-stage liver disease (ESLD), severe scar tissue in the liver (cirrhosis) makes it more difficult for blood to flow from the portal vein to the hepatic veins, thus increasing the pressure in the portal system. Because of this pressure, the blood flow gets diverted through the blood vessels surrounding the esophagus and stomach. Ultimately, the increased pressure causes varices (blood vessels with weak bulging walls) that can eventually rupture and cause a gastrointestinal bleed (GIB) into the stomach. When this occurs, an individual will have dark, bloody stools and sometimes even vomit up blood. A TIPS is often recommended when the bleeding is difficult to control.
What can I expect at California Pacific prior to my TIPS procedure?
• Prior to your TIPS, you need to schedule a pre-registration appointment with the Ambulatory Care Unit (ACU) nurse facilitator. This appointment should occur at least 1-3 days before your procedure and will take approximately two hours. To make your pre-registration appointment, call (415) 923-3303.
• The night before your procedure, you may not eat or drink anything after midnight, unless otherwise directed by your doctor. However, you may continue to take your routine medications, such as heart and blood pressure medications, with a sip of water.
• On the day of your TIPS, come to the Ambulatory Care Unit, located at 2351 Clay Street, 6th Floor, at least 2 hours before your scheduled procedure. (Note: non-English speaking patients are encouraged to come with a family member or translator.) Bring a list of any medications you are taking and your insurance information. Parking is available at 2405 Clay Street. If you need assistance getting from your car to the Ambulatory Care Unit, request the electric cart shuttle service by notifying the parking lot attendant when you arrive and take your ticket. The cart will meet you at your car in the garage and then take you to the building you are visiting. For electric cart service back to you car, notify the ACU receptionist. This transportation is available Monday to Friday, 7:30 a.m. - 5 p.m.
How is TIPS performed?
Your TIPS procedure will be performed at California Pacific's Department of Radiology by an Interventional Radiologist. Typically the procedure takes between 1-2 hours. Upon admission, the Interventional Radiologist will explain the procedure to you and your family and ask you to sign a consent form stating that you understand the procedure you are having. This is a good time for you to ask questions and share any concerns you may have. Once the consent is signed, an intravenous line (IV) will be placed in your arm to help you relax and give you medications needed during your procedure.
During your TIPS, a needle is first placed into your right jugular vein-—a large vein in your neck—-and threaded down through your superior and inferior vena cava to the hepatic vein. A catheter is then threaded over the needle and pushed through the hepatic vein and liver into the portal vein. A small balloon (associated with the catheter) is then inflated to enlarge the pathway between the hepatic and portal veins. A mesh stent is inserted between the two veins. This stent will stay in place permanently until your liver transplant at which time the entire liver, including the stent, is removed and the new liver is put in place.
What do I do after my TIPS?
After the TIPS procedure, your right neck catheter will be removed and the site will be checked for signs of bleeding. You will be monitored in the hospital for 24 hours. An abdominal ultrasound will be performed every 3-6 months following your TIPS procedure to assure it is functioning properly.
Are there any restrictions when I return home?
When you return home following your TIPS, you may resume your daily activities. You should be aware of the signs of complications, however. These danger signals to look out for include:
• Increased swelling in your abdomen and legs
• Sudden weight gain
• Restlessness
• Shortness of breath
• Encephalopathy (general confusion or memory loss)
• Increased sleepiness or fatigue
If you or your family notice any of these signs, contact your physician immediately.