Transjugular Intrahepatic Portosystemic Shunt
A TIPS is a small stent that is placed in veins within the liver to allow blood to bypass the liver, lowering the pressure within the portal system. In a TIPS procedure, the interventional radiologist uses x-rays for guidance to make a path through the liver to connect the portal vein (the vein which carries blood from the intestines to the liver) to a hepatic vein (a vein that carries blood away from the liver, to the heart). A stent is then placed in this path to hold it open.
Patients who need a TIPS have portal hypertension, increased pressure within the portal veins. This elevated pressure causes blood to flow in a backward fashion, building up pressure in the veins of the stomach, esophagus, and spleen. This increased venous pressure can cause abnormally enlarged veins to form, called varices. If the varices should rupture, uncontrollable bleeding can result. The increased pressure within the portal vein can also cause recurrent ascities or pleural effusions, large volume fluid collections which form in the abdomen or chest.
Uses of TIPS
TIPS can be used to treat the following complications of portal hypertension:
- Variceal bleeding — bleeding from any of the veins that help drain the esophagus, stomach, or intestines
- Portal gastropathy — severe enlargement of the veins in the wall of the stomach, which can rupture and cause severe bleeding
- Refractory Ascities — Accumulation of large fluid collections in the abdomen which would otherwise require frequent drainages
- Hydrothorax — Accumulation of large fluid collections in the chest which would otherwise require frequent drainages
Limitations of TIPS
Patients with much more advanced liver disease are at a higher risk of liver failure after TIPS. They also are at risk for encephalopathy, which is an alteration of normal brain function which can lead to confusion. This is because ammonia, which is normally filtered by the liver can bypass the liver. Therefore, a patient who already has encephalopathy because of liver disease may not be a good candidate for TIPS. Encephalopathy can be treated with certain medications, dietary modifications, or by reversing or narrowing the TIPS stent.
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