Special Procedures - TIPS

Radiologists perform the non-surgery procedure Transjugular intrahepatic portosystemic shunt (TIPS) to treat patients with high blood pressure due mainly to liver diseases. The major threat of portal hypertension is a tear of small blood vessels, which dilate as a result of blood flow reversal from the portal vein.

The jugular vein is first located with the use of ultrasound or fluoroscopy before TIPS is performed. The TIPS procedure is performed under conscious sedation to make the patient as comfortable as possible. A local anesthetic is injected to numb the skin and then a small incision is made. Using fluoroscopy, a catheter is inserted into the jugular vein and guided through the superior vena cava, the right atrium of the heart and into the inferior vena cava (IVC). From the IVC, the catheter is guided into a hepatic vein, the veins that drain blood from the liver to the heart.

A specialized needle is then guided through the liver parenchyma into the portal vein. Following removal of the needle over a wire, a balloon dilator is inflated to expand the tract created between the hepatic vein and portal vein, and a metal stent is placed. This permanent shunt relieves portal hypertension and varices by allowing blood to bypass the damaged liver and travel directly to the heart. The shunt is immediately studied with an ultrasound procedure to verify baseline blood flow velocities. Every 3 to 6 months an ultrasound procedure is repeated to assess any change in blood flow rate through the shunt.

Occasionally, it is necessary to do a TIPS Revision or to re-dilate the shunt with a balloon or place additional metal stents to treat thinning within the shunt. Thinning within the shunt can decrease blood flow lessen the shunts ability to work at an optimum level.