What does TIPS stand for?
TIPS stands for transjular intrahepatic portosystemic shunt:
- Transjugular – through the jugular vein in your neck
- Intrahepatic – within your liver
- Portosystemic – from the portal vein to the hepatic vein
- Shunt – a tube that allows flow from one blood system to another
What is a TIPS procedure?
A transjugular intrahepatic portosystemic shunt (TIPS) is a procedure where a path is created in the liver to connect two veins, the path is called a shunt. The shunt is held open by a small tube called a stent (see picture below). The stent will be used to connect the vein that carries blood from your esophagus, stomach, intestines and spleen (Portal Vein) to one of the three veins that carries blood away from the liver to the heart (Hepatic Veins).
Why do I need a TIPS procedure?
The normal path of blood flow to your liver is from your intestines and spleen through the portal vein. When the blood reaches the liver, it is filtered through the liver and nutrients are absorbed. The blood then drains into the hepatic veins and is carried to the heart. You have a problem with your liver that has caused increased pressure, this is called portal hypertension. This pressure buildup can cause blood to flow backward from the liver into the veins of the spleen, stomach, esophagus, and intestines, causing enlarged vessels. Occasionally these enlarged vessels can bleed, this is called variceal bleeding. This pressure can also lead to ascites or fluid in the abdomen. This condition is most commonly seen as a result of a chronic liver problem called cirrhosis (scarring of the liver).
How is TIPS done?
The TIPS procedure usually takes 2 to 3 hours but can take as long as 6 hours to complete. You will have general anesthesia for this procedure, which means you will be asleep during the procedure. Dr. Christenson will use wires and catheters (thin plastic tubes) to access your hepatic veins. To gain access to the hepatic veins he will enter through the large jugular vein in your neck. He will make a passage across the liver tissue to your portal vein and place a stent to keep the passage open. The new path will allow blood to flow directly from your portal system (esophagus, stomach, intestines, and spleen) to the vena cava (a large vein that drains blood from the upper body to the lower body and empties into the right side of the heart. This new pathway will relieve the pressure.
What are the risks of the TIPS procedure?
About 1/3 of people who have this procedure may develop or have worsening of hepatic encephalopathy (confusion, trouble concentrating, and changes in sleep patterns). Most of the time these symptoms can be managed with a medication called Lactulose. If you need to take Lactulose it is important that you take it every day and do not miss doses. Changing your diet to decrease the amount of protein may also be helpful. Dr. Christenson will also discuss this with your primary doctor. Approximately 5-10% of people may have a serious complication including but not limited to:
- Bleeding in the belly that may be life threatening
- Serious infection
- Liver disease gets worse
Please be certain that we answer all of your questions and concerns prior to the procedure.
What needs to be done to get ready for the TIPS procedure?
- You will need a pre-anesthesia consult before you have the TIPS procedure. This will be done the day of your procedure.
- If you are outpatient, we will contact you the day before your procedure to review important instructions and answer any questions you may have.
- It is important that we know if you have ever had a reaction to contrast (x-ray dye).
- If you take blood- thinning medicines like Coumadin, Lovenox, or Plavix we may ask you to stop taking those medicines 3 to 9 days before your procedure. We will give you instructions on this.
Preparing for your Procedure
- Do not eat or drink starting 8 hours before your scheduled procedure time.
- Take all of your medicines on the day of your procedure. Do NOT skip them unless we instruct you do to so.
- Bring a list of all of your medicines you take with you.
- If there is a delay in getting your procedure started it is usually because we need to treat other people with unexpected or emergency problems. Thank you for your patience if this occurs.
- A nurse or medical assistant will give you a hospital gown to put on and a bag for your belongings. Please do not bring valuable items with you.
- You may use the restroom at any time, just let the nurse know.
- An intravenous (IV) line will be started. You will be given fluids and medicine through the IV.
- Dr. Christenson will talk with you about the procedure and ask you to sign a consent form if that has not already been done. You may ask any questions you have at any time.
- You will then be given medicine to relax you and put you to sleep by an anesthesiologist. This doctor will monitor you throughout the entire procedure.
After your procedure
- After you wake up from anesthesia, you will be able to have liquids and then solid foods.
- You will stay in the hospital overnight. We will watch you closely for any signs of bleeding or infection.
- Most people go home the next day. There is no other recovery needed.
When you get home:
- You may resume taking your normal medicines. Take ONLY the medicines your doctors prescribed and approved.
- You will be scheduled for a follow up appointment in 1 week. We will tell you the date and time before you are discharged from the hospital. It is important that you keep this appointment.
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