What is Transjugular Intrahepatic Portosystemic Shunt Insertion (TIPS)

Transjugular intrahepatic portosystemic shunt insertion is a procedure to restore blood flow through the liver. This procedure may be done when a blockage has caused problems with the normal flow of blood through the liver, resulting in increased pressure (hypertension) in the vein that carries blood to the liver (portal vein). Portal hypertension is usually caused by scar tissue from liver disease, such as cirrhosis. It can cause serious problems. A TIPS procedure may be done if portal hypertension or liver disease has caused problems such as:

• Bleeding from the esophagus or stomach.
• Buildup of fluid in the abdomen.

In a TIPS procedure, a new pathway for blood flow is created through the liver. A small wire-mesh tube called a shunt or stent is placed inside the pathway to keep it open. The shunt is passed down the jugular vein in your neck. Then, the shunt is inserted between the portal vein and a vein on the other side of the liver (hepatic vein), which is a vein that blood flows through when it leaves the liver. The shunt connects these blood vessels and improves blood flow across the liver.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Allergic reactions to medicines or dyes.
• Bleeding into the abdomen.
• Irregular heartbeat (cardiac arrhythmia).
• Decline in brain function (encephalopathy) in people with severe liver disease. This may be a problem after the TIPS has been inserted, and it may require treatment. People who have had encephalopathy may not be good candidates for TIPS.
• Blockage of the shunt. This may lead to a return of the problems. If this occurs, a new shunt can be placed or the existing shunt can be adjusted. You will have ultrasound exams to evaluate for a blockage of the shunt.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

Ask your health care provider about:

• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.

General instructions

• You may have blood tests to see how well your kidneys and liver are working and to see how well your blood can clot.
• Plan to have someone take you home from the hospital or clinic.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the neck area (local anesthetic).
  • A medicine to make you fall asleep (general anesthetic).
• A needle will be used to make a small hole in a vein in the right side of your neck. Needles and long, thin, flexible tubes (catheters) will be moved through the hole down to the veins in your liver.
• Dye will be injected through a catheter, and X-ray images will be taken. This will help your surgeon see the blood flow around your liver. As the dye passes through the blood vessels in your body, you may experience a warm feeling.
• A needle will be inserted across the liver to make a connection with a branch of the portal vein. This channel will be expanded, and the shunt will be inserted and left in place.
• The needle and catheter will be removed.
• Pressure will be applied to your neck to prevent bleeding. A bandage (dressing) will be applied.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• Your health care provider will watch for signs of complications.
• You will be instructed to keep your head raised (elevated) above the level of your heart for a few hours after the procedure. This will help to prevent bleeding from the insertion site in your neck.
• You may feel mild stiffness in your neck where the needle was inserted.
• An ultrasound may be done the morning after the procedure to make sure that the shunt is open and working well.
• Do not drive for 24 hours if you were given a sedative.

Transjugular Intrahepatic Portosystemic Shunt Insertion, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Less abdominal discomfort after the placement of the stent.
• Mild stiffness in your neck.

Follow these instructions at home:

• Do not drive for 24 hours if you were given a medicine to help you relax (sedative) during your procedure.
• You may remove the bandage (dressing) from your neck as told by your health care provider.
• Follow any instructions from your health care provider about eating or drinking.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You develop a rash.
• You have bleeding from the place in your neck where the needle was inserted.

Get help right away if:

• You have shortness of breath.
• You feel faint or you pass out.
• You have chest pain.
• You have difficulty breathing.
• You have a cough or you cough up blood.
• You have weakness.
• You have difficulty moving your arms or legs.
• You develop balance problems.
• You have problems with speech or vision.
• You become confused.