Transjugular Intrahepatic Portosystemic Shunt (TIPS)

If you have chronic liver disease, such as cirrhosis, and you have varices (enlarged veins in your abdomen), which are prone to uncontrolled bleeding, your doctor may recommend a procedure that creates a new connection between two of the blood vessels in your liver. TIPS redirects blood flow and reduces hypertension (high blood pressure) in the portal vein system, veins which drain blood from your stomach and intestine into the liver. By reducing this pressure, TIPS may reduce internal bleeding in the stomach and esophagus.

What happens during TIPS?

You will have already discussed the treatment options with the physician doing the procedure. Prior to your procedure, we’ll take you to a preparation area where our nurses will start an IV in your arm and give you any medication that may be required prior to your procedure. We may give you medicines to protect your kidneys, antibiotics to help prevent infection, and anti-nausea medications. You may have a Foley catheter (tube) placed into your bladder.

When it’s time to begin, we’ll take you to a special room that is similar to an operating room. We often use general anesthesia, so you may not be aware of the rest of the procedure. Alternatively, you may receive conscious sedation, or mild anesthesia. In this case, you’ll remain slightly awake throughout the procedure.

During the procedure, you’ll lie on your back on a table and we’ll clean the area above the right collarbone with a special solution to minimize infection. This is where the catheter (a thin, hollow tube) will enter your body. We’ll place sterile drapes over your body and an interventionalist will apply a local anesthetic so you don’t feel any pain.

Your interventionalist will make a small incision in your neck, insert a catheter into the jugular vein and, using x-ray for guidance, insert the catheter all the way to the liver. Once the catheter is in place, we’ll use a special needle to make a tiny hole between one of the liver veins and the portal vein. Then, we’ll insert a deflated balloon through the hole and inflate it in the liver to create the opening for a special stent. The stent will connect the portal vein to one of the hepatic veins so that most of the blood draining from the intestines (bowel) will skip the liver on the way back to the heart.

At the end of the procedure, your interventionalist will withdraw the catheter and apply pressure at the place where the catheter went into the jugular vein to stop the blood from leaking out. Finally, we’ll put a bandage over the incision.

After your procedure, your interventionalist will review the results of your TIPS with you and your physician so he or she can discuss the next steps with you. We typically ask you to return so the interventionalist can check how well you have done after your procedure and to see if your stent remains open or you need any other procedures to make you better.