TIPS Procedure

September 3, 2024

This page was reviewed under our medical and editorial policy by Jonathan Kessler, M.D., associate clinical professor, division of interventional radiology, Department of Diagnostic Radiology, City of Hope^® Cancer Center Duarte

A transjugular intrahepatic portosystemic shunt, or TIPS, is a minimally invasive procedure performed by an interventional radiologist. A shunt is a new passageway made by an interventional radiologist with a thin, flexible tube, and it allows blood or fluid to move to a different area. Minimally invasive procedures involve a tiny cut in the skin to access inside the body.

A TIPS procedure helps to lower high blood pressure in the liver (known as portal hypertension) by allowing some blood to flow away from the liver.

This technique may be particularly helpful for patients having complications, such as bleeding in the esophagus or stomach (varices) or fluid buildup in the abdomen (ascites) from portal hypertension.

Portal hypertension is usually caused by liver diseases, such as hepatitis or cirrhosis, but in rare instances it may also be linked to cancer cells in the liver or certain types of chemotherapy medications.

What Is a TIPS Procedure?

A TIPS procedure uses imaging techniques, like X-ray and ultrasound, to guide the creation of a pathway between two major veins in the liver: the portal vein and the hepatic vein. The portal vein carries blood to the liver from the digestive organs, while the hepatic vein takes blood from the liver back to the heart.

A TIPS procedure is often recommended for patients who experience repeated variceal bleeding that does not respond to medication or other treatments. It may also be used in patients with ascites that is uncontrolled despite dietary changes, medications or repeated fluid removal.

During a TIPS procedure, the patient is placed under general anesthesia in a specialized interventional radiology suite so he or she is fully asleep during the procedure. The medical team connects the patient to monitors that track important vital signs, including heart rate, blood pressure, oxygen levels and pulse.

Once the patient is sedated, the doctor numbs a small area just above the collarbone with a local anesthetic to prevent any discomfort. After numbing, the doctor makes a tiny incision in this area. Using ultrasound guidance, the doctor identifies the jugular vein, a large vein in the neck, and carefully inserts a catheter — a thin, flexible tube — into it. The catheter is then guided down into the liver using X-ray imaging.

Once the catheter reaches the liver, the doctor connects the hepatic vein to the portal vein using a small needle. Once connected, a small flexible tube called a stent is placed permanently connecting the two veins. This pathway allows blood to bypass the liver and reduces pressure in the veins of the stomach, esophagus and intestines.

After placing the stent and confirming the portal vein pressure is lower, the doctor removes the catheter and applies a small bandage to the incision site. Usually, no stitches are needed.

Recovery

After a TIPS procedure, the patient spends time recovering in his or her hospital room under close observation. The health care team monitors for any signs of bleeding, and the patient keeps his or her head elevated for a few hours to minimize the risk of complications.

If the procedure is elective, the patient may feel well enough to go home the next day. However, if a TIPS procedure was performed urgently due to significant bleeding, a longer stay in the intensive care unit might be necessary to ensure a safe recovery. Most patients experience little to no pain after the procedure and usually may resume normal activities within seven to 10 days.

Before leaving the hospital, doctors typically perform an ultrasound to confirm the stent is in place and functioning correctly. Follow-up ultrasounds are scheduled in the weeks and months following the procedure to make sure the shunt remains open and continues to work as intended.

The interventional radiologist will inform the patient on the day of the procedure about its success. In most cases, a TIPS procedure is successful, with about 80% to 90% of patients finding relief from the complications of portal hypertension, according to the U.S. National Library of Medicine. With proper follow-up care, most patients recover well and are able to return to their regular routines.

TIPS Procedure Complications

All surgeries and procedures carry the risk of some side effects or complications. After a TIPS procedure, patients may experience the following complications:

• Infection
• Allergic reaction to contrast material
• Blood vessel damage
• Bruising or bleeding at the insertion site
• Fever and muscle stiffness
• Delayed narrowing (stenosis) or complete blockage (occlusion) of the stent

Serious complications have been reported in less than 5% of TIPS procedures, according to the Radiological Society of North America. These include severe liver injury, heart arrhythmias, congestive heart failure and, in rare cases, death. Interventional radiologists who perform TIPS procedures are specially trained to minimize these risks and reduce them to as low a level as possible.