A transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive procedure to create an artificial channel between the portal vein and the hepatic vein.

Normally, the portal vein carries blood from the intestine and spleen to the liver. This blood then passes through tiny channels surrounding the liver cells. The nutrients and toxins are filtered out by the liver cell. The blood then passes through the hepatic vein to drain into vena cava and heart.

Any blockage in this normal flow pathway results in pressure build up in the portal vein, known as portal hypertension. The commonest cause of the obstruction to the blood flow is due to scarring within the liver, Known as cirrhosis. Portal hypertension causes the diversion of blood around the liver, which creates an enlargement of venous channels in the walls of the food pipe (esophagus), stomach, and abdomen. Increased pressure within these enlarged venous channels, or varices, can cause bleeding. Other common effects of portal hypertension are fluid build-up in the abdomen, known as ascites, or chest, known as pleural effusion.

By creating an artificial channel between portal vein and hepatic vein, TIPS reduces the pressure within the portal system and thereby reduces or alleviates the effect of portal hypertension such as ascites, pleural effusion or variceal bleeding. While this is the aim of the procedure, it is not free from negative effects.

The University of Miami Health System interventional radiologists use imaging guidance to perform this innovative procedure.

Who is a Candidate?

Ascites and pleural effusion due to portal hypertension are initially treated with medications and varices in the esophagus are initially treated with medications and banding procedure performed through endoscope. If the ascites, pleural effusion or bleeding varices cannot be successfully controlled with medications, TIPS is performed in select patients.

Your doctor will determine your overall chance of successful outcome and any possible complications after evaluating your general health, severity of the liver disease, baseline heart, and kidney functions. A team of specialists, including a hepatologist, interventional radiologist and transplant team, if needed, can determine if TIPS is a right choice for you.

What to Expect

Your doctor may tell you not to eat or take certain medications, like aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) before your procedure. Always tell your doctor what medicines you are taking, including vitamins or herbs.

You will be given general anesthesia before your TIPS procedure so that you sleep during the procedure and do not feel any pain or discomfort.

After you are asleep, your doctor will make an incision in the jugular vein in your neck. They will insert a catheter (thin plastic tube) through the incision. Using X-ray guidance, they will guide the catheter to the portal vein in your liver.

Next, they will use specialized tools to create a tunnel between your portal vein and your hepatic vein — both located in the liver. They will then place a stent (wire mesh tube) into the new pathway to keep it open. Because blood can now flow through a new pathway, your portal vein is not under as much pressure. This relieves portal hypertension and abdominal bleeding in most patients.

Once the stent is in place, your doctor will remove the catheter and close the incision on your neck. The entire procedure takes about two to three hours. You will be able to go home the day after your TIPS procedure (outpatient procedure) and may be able to resume normal activities within a couple of weeks.

Despite the success rate of TIPS, diverting blood from the portal circulation to hepatic veins may cause following unwanted consequences.

• Hepatic encephalopathy: Since the ammonia produced in the intestines now bypasses liver, it can cause negative effect on the brain known as hepatic encephalopathy. Usually, it can be prevented or controlled by medications.
  
  
• Liver failure: As the portal blood is now diverted from the liver tissue directly to the general circulation, it may affect liver function negatively. Fortunately, liver has dual blood supply and supply from the hepatic artery is usually sufficient to prevent overt liver failure.
  
  
• Heart failure: The diversion causes increase in the blood volume reaching the heart and may lead to heart failure in patients with borderline heart disease.

Apart from these, other complications include internal bleeding, kidney failure due to use of iodine containing dye during the procedure, biliary injury or injury to organs surrounding the liver, and very rarely fatal internal bleding.

Why Choose UHealth?

Expert care from highly trained interventional radiologists. Our interventional radiologists and radiology specialists are experts in a variety of minimally invasive procedures — everything from treatments to clear blocked blood vessels to advanced cancer therapies like NanoKnife®.

Leading-edge imaging care in South Florida. Our doctors are also researchers discovering new ways to improve diagnosis and treatment. That means you can get some of today’s most promising advancements through clinical trials. You benefit from the latest developments that are fast-tracked from the lab to the bedside.