The Transjugular Intrahepatic Portosystemic Shunt (TIPS) is a specialized, minimally invasive procedure used to manage severe complications of liver disease. Performed by interventional radiologists, the TIPS procedure creates an artificial channel within the liver to redirect blood flow. This effectively reduces pressure in the veins leading to the organ, decompressing the circulatory system and alleviating dangerous symptoms.
The Core Problem TIPS Addresses
The primary condition necessitating a TIPS procedure is portal hypertension, which is abnormally high blood pressure within the portal vein system. This system collects blood from the stomach, intestines, and spleen, carrying it to the liver. Liver diseases, particularly cirrhosis, cause scarring that resists this blood flow, leading to a dangerous pressure backup throughout the portal system.
This increased pressure forces blood to find alternative routes around the liver, causing fragile, enlarged veins called varices, often in the esophagus and stomach. These varices can rupture, leading to life-threatening internal bleeding. The persistent high pressure also causes fluid to leak into the abdominal cavity, a condition known as ascites.
When ascites becomes refractory, meaning it resists standard treatments like diuretics, it causes significant discomfort and risk of infection. The pressure within the liver must be reduced to resolve both variceal bleeding and fluid buildup. The TIPS procedure offers a powerful method to lower this pressure when medication and other interventions have failed.
How the TIPS Procedure is Performed
The TIPS procedure is an endovascular technique, performed entirely from within the blood vessels without the need for traditional open surgery. The process begins with the interventional radiologist accessing the internal jugular vein in the neck through a small puncture site. A catheter is then threaded down the vein, through the heart, and into one of the hepatic veins inside the liver.
Using continuous X-ray guidance (fluoroscopy), the radiologist employs a specialized needle to puncture through the liver tissue. This needle creates a tract that connects the hepatic vein to a branch of the portal vein, establishing the bypass channel within the liver’s structure.
Once the connection is established, the tract is widened using a balloon catheter. A metal mesh tube, known as a stent, is then deployed within this tract to keep the channel permanently open. The stent functions as the shunt, diverting a portion of the portal blood flow directly into the hepatic vein, which drains blood back to the heart.
This bypass effectively decompresses the portal system, immediately reducing the pressure causing complications. The procedure is monitored with contrast dye and pressure measurements to ensure the shunt is functioning correctly. Because the procedure is minimally invasive, it is associated with a shorter recovery time compared to open abdominal surgery.
Living with a TIPS Shunt
Following the procedure, patients are monitored closely in the hospital, often for one or two days, to watch for immediate issues. Once discharged, long-term management focuses on monitoring the shunt’s function and managing potential metabolic changes. A primary concern is maintaining shunt patency, ensuring the stent remains open and unobstructed.
The shunt can narrow or become blocked over time due to the growth of new tissue within the stent, a process called intimal hyperplasia. To monitor for this, patients undergo regular surveillance, typically involving a Doppler ultrasound of the liver to measure blood flow velocity. If flow is suboptimal, a follow-up procedure may be required to widen the shunt or place a second stent to restore proper function.
The most significant trade-off of the TIPS procedure is the increased risk of developing hepatic encephalopathy (HE). By bypassing the liver, the shunt diverts blood containing intestinal toxins, such as ammonia, directly into the general circulation, where they can reach the brain. This can cause a reversible decline in brain function, leading to symptoms like confusion, disorientation, or forgetfulness.
Hepatic encephalopathy is managed through specific medications, such as lactulose, which reduces the production and absorption of ammonia in the gut. Antibiotics like rifaximin and dietary modifications, including moderate protein restriction, are also often recommended to help control ammonia levels. While the shunt provides relief from life-threatening bleeding and fluid retention, these long-term consequences require careful management.