Interventional Radiology: Gallbladder, Bile, Ducts and Liver
TIPS

TIPS (transjugular intrahepatic portosystemic shunt) is non-surgically performed by the interventional radiologist to treat patients with portal hypertension (elevated blood pressure) due primarily to liver disease such as cirrhosis of the liver, tumor encasement of the portal vein or a congenital malformation. The major threat of portal hypertension is rupture of varices (small blood vessels), which dilate as a result of blood flow reversal from the portal vein (main blood supply to the liver).

Prior to TIPS, the jugular vein in the neck is located with ultrasound or fluoroscopy. To maximize patient comfort and cooperation TIPS procedure is performed under conscious / IV sedation. The skin is then numbed with a local anesthetic and a 1/4 inch incision is made. Under fluoroscopy, a catheter is inserted into the jugular vein and advanced through the superior vena cava, the right atrium of the heart and into the inferior vena cava (IVC). From the IVC, the catheter is advanced into a hepatic vein (the veins that drain blood from the liver to the heart).

A specialized needle is then advanced 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 (device) is placed. This permanent tract (shunt) relieves portal hypertension and varices by allowing blood to bypass the damaged liver and travel directly to the heart. The shunt is immediately evaluated with ultrasound to document baseline blood flow velocities. Every 3 to 6 months ultrasound is repeated to evaluate for possible change in blood flow velocity through the shunt.

Occasionally, it is necessary to re-dilate the shunt with a balloon or place additional metal stents to treat narrowings within the shunt. Narrowings within the shunt can decrease blood flow and threaten shunt patency. This procedure, called TIPS revision is less complex and invasive than the initial TIPS procedure, but similarly involves placement of a needle into the jugular vein and manipulation of multiple guidewires and catheters through the superior vena cava, right atrium of the heart, inferior vena cava and TIPS shunt.