A transjugular intrahepatic portosystemic shunt (TIPS) procedure is a treatment method used to reduce portal hypertension, or excessive pressure in the portal vein.
This vein is responsible for transporting blood from the abdomen to the liver. The excess pressure can cause significant bleeding and a buildup of fluid in the abdomen, known as ascites.
Read on to learn more about the TIPS procedure, including why you might need it, how doctors perform it, and possible side effects that could result from this procedure.
A TIPS procedure involves creating a bypass between the portal vein and the hepatic vein by placing a stent. Here are each of the three parts of the procedure:
Derivation: Something that diverts or redirects the flow from its normal path. Portal: The vein that carries blood from the gastrointestinal system, gallbladder, pancreas, and spleen to the liver.hepatic vein: The veins (usually three) that return deoxygenated blood from the liver to the heart.
A specialist known as an interventional radiologist will perform the procedure, usually in a specialized operating room known as an interventional radiology suite. During this time, an interventional radiologist will use x-ray guidance to place the shunt.
People who need a TIPS procedure are usually moderately or severely ill.
Examples of acute conditions and events that may warrant a TIPS procedure include:
Budd-Chiari syndrome: A rare disorder that affects the ability of blood to leave the liver, leading to significant portal hypertension.Hepatopulmonary syndrome: A syndrome that occurs in people with significant liver disease that affects the ability of their lungs to function well.Hepatorenal syndrome: A condition in which a person experiences significant liver failure that also affects the way their kidneys work.Portal hypertensive gastropathy: Bleeding in the stomach and stomach lining due to portal hypertension.Refractory ascites: Ascites (severe swelling in the abdomen) that does not respond to traditional treatments.Refractory hepatic hydrothorax: Severe pleural effusion (accumulation of fluid outside the lungs) that is the result of significant liver disease.Variceal bleeding: A condition that causes the veins in the esophagus or stomach to bleed profusely.
As you can probably tell from these directions, the liver is an important recipient and transporter of blood in your body. When your liver malfunctions, its malfunction can affect multiple organ systems and cause symptoms that may become indicators for the TIPS procedure.
Doctors will usually perform a TIPS procedure after other first-line treatments have failed. For example, doctors may try to reduce ascites by draining excess fluid or fluid from varices by banding or stopping bleeding in the esophagus. If these fail, a doctor may recommend a TIPS procedure.
As with any procedure, the TIPS procedure is not without its side effects. Those who need the procedure are often very ill, which can increase the risk of side effects. A doctor should explain in detail the pros, cons, and risks of the procedure.
Physicians perform the TIPS procedure under general anesthesia (where you are completely asleep without realizing it) or under conscious sedation. While approaches may vary from person to person, the following are some of the basic steps for a TIPS procedure:
An interventional radiologist will cannulate (access) your right internal jugular vein. The radiologist will advance the catheter into your right hepatic vein. A doctor will guide you by ultrasound to identify your portal veins. After identifying the portal veins, the surgeon will place a stent that extends to where the hepatic vein and inferior vena cava join. A doctor may also need to embolize (destroy with heat) other bleeding areas of your body. The doctor will measure the pressures in the portal veins and right atrium of your heart to make sure the shunt is working properly. They will also measure blood flow velocity through ultrasound to ensure blood is flowing through the shunt properly. Your doctor will remove the catheters and you will be taken to the post-anesthesia recovery unit, where you will be closely watched by healthcare professionals.
The TIPS procedure usually takes between 1 and 2 hours.
However, if your case is very complicated, the procedure may take longer.
Some people should not have a TIPS procedure. People who absolutely should not have a TIPS procedure include those with:
Obstruction of the bile ducts Liver cysts that prevent advancement or placement of a stent Right heart failure Sepsis or serious systemic infections Severe pulmonary hypertension
The mortality rate of a TIPS procedure is less than 1% and the 30-day mortality rate is less than 3%. This means that after 30 days, 97% of people who underwent the procedure are alive.
The most common causes of death from the TIPS procedure are organ failure and hemobilia, or bleeding within the biliary system.
You will likely stay in a hospital for at least 24 hours after a TIPS procedure. This allows medical staff to monitor your blood pressure, heart rate, circulation, and urine output. Your doctor will check other blood tests that show how well your heart and liver are working and make sure you don’t have any internal bleeding.
Before you are allowed to go home, your doctor will perform an ultrasound of your abdomen to identify how well blood is flowing in the portal vein and to make sure the stent is working properly.
A TIPS procedure does not cure the underlying disorders that cause ascites and bleeding. As a result, doctors do not consider it 100% effective.
Often, those who undergo a TIPS procedure may be listed for a liver transplant, which could correct underlying disorders.
The outcome for people with portal hypertension is poor. The survival rates and outlook for people after having the TIPS procedure depend on why they needed the TIPS procedure and their general health. People who have the TIPS procedure because of ascites usually have a better prognosis than those who have bleeding varices.
The following are some frequently asked questions after a TIPS procedure.
Is there a special diet after a TIPS procedure?
Your doctor may recommend a healthy diet after your TIPS procedure. Examples of interventions include a low-protein diet and a low-sodium diet. Immediately after the procedure, your doctor may recommend that you eat no more than 20 grams of protein per day for 3 days to reduce the risk of postoperative side effects.
Will I need a liver transplant after a TIPS procedure?
Over time, the TIPS procedure can decrease how well your liver works. The effect is likely due to decreased blood flow to the liver. The underlying reasons why you needed a TIPS procedure and undergoing the TIPS procedure itself may be indications for a liver transplant. However, there are many factors that influence whether you need a liver transplant. You should discuss whether you are a candidate given your age and general health.
What is the life expectancy after a TIPS procedure on the liver?
A TIPS procedure can reduce a person’s mortality compared to no intervention. Those who do not undergo TIPS procedures but may be candidates have a mortality rate of 40% compared to those who undergo TIPS procedures, whose mortality rate is between 20% and 35%.
A TIPS procedure can reduce portal hypertension without requiring significant open surgery. Because the procedure does not correct the underlying problems of liver dysfunction, you may need further treatments to improve the health of your liver after the procedure. A doctor should carefully explain the risks and benefits of the procedure to you before you undergo it.
Source: news.google.com