Transjugular intrahepatic portosystemic shunt (TIPS)

TIPS is a minimally invasive treatment for portal hypertension. Portal hypertension is high blood pressure in the veins that carry blood from your digestive organs in your abdomen to your liver. People with severe liver failure and cirrhosis are most likely to have portal hypertension.

The TIPS procedure drains blood away from the portal veins to reduce the pressure inside the vessels. It can help prevent or treat dangerous complications such as excessive bleeding if a vein ruptures or ascites (fluid build-up in your abdomen).

A TIPS is a stent-graft (flexible, mesh tube) placed inside your liver that connects your main portal vein with your hepatic vein. The hepatic vein drains blood from your liver and sends it back to your heart. The shunt between the two blood vessels creates a new passageway to relieve pressure from the portal vein system.

During the TIPS procedure, an interventional radiologist uses catheters and imaging guidance to place the shunt through a small incision in your neck. It’s a simpler, less invasive alternative to portocaval shunting, a major surgery for portal hypertension that requires a large incision in your abdomen. The TIPS procedure allows you to recover faster and with less pain.

A TIPS is one treatment for complications related to portal hypertension and cirrhosis. We may recommend a TIPS if you have variceal bleeding (bleeding from weakened, dilated veins) or ascites that doesn’t improve with other treatments.

Your health-care provider will discuss the following therapies with you and determine which is best for your needs:

• Medication: Drugs called non-selective beta-blockers help control blood pressure.
• Endoscopic sclerotherapy: An injection of a chemical solution into abnormal veins seals them off and stops bleeding.
• Variceal band ligation: Abnormal veins are tied off using small rubber bands.
• Portocaval shunting: Major surgery to connect the portal vein to the inferior vena cava, diverting blood from the liver.
• Liver transplant: People with severe liver disease may need surgery to replace their liver with a healthy liver from a donor.

A TIPS is for people with portal hypertension related to severe liver disease or cirrhosis, which is often the result of excessive alcohol use, fatty foods, or viral infections such as hepatitis. We may recommend liver shunting if you have:

• Fluid build-up in your abdomen that causes a bloated stomach
• Fluid build-up in your lungs that causes shortness of breath
• Gastrointestinal bleeding that can lead to blood in your stool or vomit

Before the TIPS procedure, we do a physical exam, blood tests, and imaging scans. Tell your doctor about any medications you take, especially aspirin, blood thinners, or nonsteroidal anti-inflammatory drugs (NSAIDs). You may need to stop taking these medications. Your care team will give you detailed instructions about how to prepare. Don’t have anything to eat or drink after midnight before your procedure.

An interventional radiologist performs the TIPS procedure in an operating room or interventional radiology suite. The procedure typically lasts between one and three hours but may take longer. Most people stay in the hospital overnight.

During the TIPS procedure, here’s what you can expect:

1. You may receive a sedative or general anesthesia.
2. A nurse applies a local anesthetic to your skin to numb the area.
3. We may give you an injection of a contrast dye, which helps us see blood vessels more clearly.
4. An interventional radiologist makes a small incision (cut) in your neck, just above your collarbone.
5. They insert a balloon-tipped catheter (thin, flexible tube) into your jugular vein.
6. Using ultrasound guidance, they advance the catheter, stent-graft, and a needle to the hepatic vein in your liver.
7. They use the needle to create a tunnel between the hepatic vein and portal vein, then connect the two vessels with the stent-graft.
8. The balloon is inflated to expand the stent-graft into the correct position.
9. The interventional radiologist removes the catheter and balloon, then places a bandage over the incision in your neck.

After the procedure, we monitor you for one to two days in the hospital. Your care team makes sure you don’t have any significant bleeding or other symptoms. You should be able to return to normal activities within one or two weeks. We do follow-up imaging exams to make sure the stent-graft is working correctly. We also do blood tests to monitor your liver function.

Complications from the TIPS procedure aren’t common, but can include:

• Allergic reaction to contrast material
• Bleeding
• Blood clots
• Blood vessel damage
• Infection
• Stenosis (narrowing) or blockage of the stent

Penn Medicine is home to a nationally renowned interventional radiology program with specialists who routinely treat conditions such as cirrhosis and portal hypertension using minimally invasive techniques. When you turn to us for care, you’ll find:

• Collaborative approach: Experts in interventional radiology, gastroenterology, hepatology, and transplant surgery work together to plan your care. They select the right treatments at the right time to optimize your quality of life.
• Advanced techniques: We use the latest imaging technology, stent-grafts, and minimally invasive techniques to make your treatment as safe and effective as possible. Our commitment to quality leads to better outcomes for our patients.
• Specialized expertise: We have a depth and breadth of expertise in liver diseases that’s unmatched in the region. Our gastroenterologists routinely treat people with cirrhosis, liver cancer, and liver failure. We also have one of the top 10 liver transplant programs in the nation.