Table of ContentsView AllTable of ContentsWhat Is TIPS?Purpose of a TIPS ProcedureHow to PrepareWhat to Expect on the Day of the ProcedureRecovery
Table of ContentsView All
View All
Table of Contents
What Is TIPS?
Purpose of a TIPS Procedure
How to Prepare
What to Expect on the Day of the Procedure
Recovery
It’s a minimally invasive procedure (not a surgery) that allows an interventional radiologist to place a stent into the liver under image guidance through a small access point in the neck.
Sebastian Kaulitzki / Science Photo Library / Getty Images
TIPS is a connection created between a vein in the liver (hepatic vein) and a branch of the portal vein to reduce pressure in theportal vein. A portal vein transports blood to the liver from the spleen, stomach, pancreas, and intestines.
A TIPS procedure is performed under image guidance. Dye is injected at different points to allow the radiologist to effectively see the veins.
There are several steps to the procedure:
Contraindications
Potential Risks
Every procedure comes with a certain level of risks, and some are more likely than others. Potential risks of TIPS include:
There are several conditions that a person might have that would indicate a need for the TIPS procedure:
A TIPS procedure is not the first line of treatment for many of these conditions that stem from severe liver disease. There are other options to treat the symptoms prior to pursuing this option. Your doctor may decide to try this approach to prevent excessive bleeding.
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One of the guidelines for deciding when to pursue a TIPS procedure is persistent bleeding and severe rebleeding within five days of treatment. In this scenario, the rebleeding should be managed with a TIPS procedure. The procedure, if successful, is likely to lower mortality and improve control of ascites.
Testing such as blood work and imaging—computed tomography (CT) scan or magnetic resonance imaging (MRI)—will be done before the procedure to see the patient’s anatomy to assess for likelihood of a successful procedure. The blood work includes a complete blood count (CBC), liver function tests, and a coagulation profile (clotting status).
Esophageal Varices With or Without Rupture
Location
What to Wear
It’s important to arrive on the day of the procedure wearing comfortable clothes. Comfortable pants and shoes are a good choice, and potentially a sweater or jacket because the hospital can be cold. Patients will be asked to change into a procedure gown prior to entering the procedure room.
Food and Drink
Medications
Patients should provide a thorough list of current medications and alert the doctor to any changes in or skipped medications on the day of the procedure. The doctor will determine if medications or supplements that can cause increased bleeding should be continued or stopped depending on the medical situation of each patient.
What to Bring
It’s important to bring a photo ID and insurance cards on the day of the procedure. An overnight bag with any belongings (such as glasses or a phone charger) should be available for an overnight stay in the hospital.
Before the Procedure
In the preoperative area on the day of the procedure, a nurse will assess your vital signs, weight, pregnancy status (if applicable), and blood sugar levels (if applicable). Patients will remove their clothes and jewelry, and change into a surgical gown that allows the radiologist to easily access the procedure site.
During the Procedure
When the radiologist deploys the stent, there may be some pressure or pain in the abdominal area. This is expected and normal during this procedure.
After the Procedure
Patients undergoing TIPS should expect to wake up from general anesthesia in a recovery room and then be transferred to a hospital room to stay overnight to monitor for bleeding or other complications. The minimally invasive approach reduces the time it takes to recover from the procedure.
After the surgery, your doctor will likely recommend that you follow a strict low-protein diet of 20 grams or less per day for three days, and then slowly increase the amount.This is to prevent a severe brain disorder called hepatic encephalopathy in which toxins are built up in the bloodstream due to decreased liver metabolism.Your medical provider will provide you with additional guidelines to follow for a healthy diet.
Healing
There is not usually pain following the procedure, although there may be some soreness. A small dressing will cover the incision in the neck. It may take about seven to 10 days to return to everyday activities.
Long-Term Care
The radiologist will use ultrasound to confirm that the shunt is functioning and that it is open to allow blood flow about seven to 14 days after the procedure. The shunt will continue to be monitored at three months, six months, and then every six to 12 months following the procedure.
More detailed imaging, such as a CT scan, may be used periodically to check that the stent is wide open and flowing freely.
Summary
The TIPS procedure can help reduce high blood pressure in the portal veins, which filter blood from the intestines through the liver, and its complications, especially bleeding when these veins burst from the increased pressure. It’s typically used to help with liver conditions like hepatitis and cirrhosis. It’s not recommended for everyone with these conditions, and your doctor will help you determine whether this procedure is right for you.
6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.MedlinePlus.Transjugular intrahepatic portosystemic shunt (TIPS).Dariushnia SR, Haskal ZJ, Midia M, Martin LG, Walker TG, Kalva SP, Clark TW, Ganguli S, Krishnamurthy V, Saiter CK, Nikolic B; Society of Interventional Radiology Standards of Practice Committee.Quality Improvement Guidelines for Transjugular Intrahepatic Portosystemic Shunts.J Vasc Interv Radiol. 2016 Jan;27(1):1-7. doi:10.1016/j.jvir.2015.09.018Dariushnia SR, Haskal ZJ, Midia M, Martin LG, Walker TG, Kalva SP, Clark TW, Ganguli S, Krishnamurthy V, Saiter CK, Nikolic B; Society of Interventional Radiology Standards of Practice Committee.Quality Improvement Guidelines for Transjugular Intrahepatic Portosystemic Shunts.J Vasc Interv Radiol. 2016 Jan;27(1):1-7. doi:10.1016/j.jvir.2015.09.018García-Pagán JC, Saffo S, Mandorfer M, Garcia-Tsao G.Where does TIPS fit in the management of patients with cirrhosis?JHEP Rep. 2020 May 23;2(4):100122. doi:10.1016/j.jhepr.2020.100122Luo L, Fu S, Zhang Y, Wang J.Early diet intervention to reduce the incidence of hepatic encephalopathy in cirrhosis patients: post-Transjugular Intrahepatic Portosystemic Shunt (TIPS) findings.Asia Pac J Clin Nutr. 2016;25(3):497-503. doi:10.6133/apjcn.092015.14MedlinePlus.Loss of brain function - liver disease.
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.MedlinePlus.Transjugular intrahepatic portosystemic shunt (TIPS).Dariushnia SR, Haskal ZJ, Midia M, Martin LG, Walker TG, Kalva SP, Clark TW, Ganguli S, Krishnamurthy V, Saiter CK, Nikolic B; Society of Interventional Radiology Standards of Practice Committee.Quality Improvement Guidelines for Transjugular Intrahepatic Portosystemic Shunts.J Vasc Interv Radiol. 2016 Jan;27(1):1-7. doi:10.1016/j.jvir.2015.09.018Dariushnia SR, Haskal ZJ, Midia M, Martin LG, Walker TG, Kalva SP, Clark TW, Ganguli S, Krishnamurthy V, Saiter CK, Nikolic B; Society of Interventional Radiology Standards of Practice Committee.Quality Improvement Guidelines for Transjugular Intrahepatic Portosystemic Shunts.J Vasc Interv Radiol. 2016 Jan;27(1):1-7. doi:10.1016/j.jvir.2015.09.018García-Pagán JC, Saffo S, Mandorfer M, Garcia-Tsao G.Where does TIPS fit in the management of patients with cirrhosis?JHEP Rep. 2020 May 23;2(4):100122. doi:10.1016/j.jhepr.2020.100122Luo L, Fu S, Zhang Y, Wang J.Early diet intervention to reduce the incidence of hepatic encephalopathy in cirrhosis patients: post-Transjugular Intrahepatic Portosystemic Shunt (TIPS) findings.Asia Pac J Clin Nutr. 2016;25(3):497-503. doi:10.6133/apjcn.092015.14MedlinePlus.Loss of brain function - liver disease.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
MedlinePlus.Transjugular intrahepatic portosystemic shunt (TIPS).Dariushnia SR, Haskal ZJ, Midia M, Martin LG, Walker TG, Kalva SP, Clark TW, Ganguli S, Krishnamurthy V, Saiter CK, Nikolic B; Society of Interventional Radiology Standards of Practice Committee.Quality Improvement Guidelines for Transjugular Intrahepatic Portosystemic Shunts.J Vasc Interv Radiol. 2016 Jan;27(1):1-7. doi:10.1016/j.jvir.2015.09.018Dariushnia SR, Haskal ZJ, Midia M, Martin LG, Walker TG, Kalva SP, Clark TW, Ganguli S, Krishnamurthy V, Saiter CK, Nikolic B; Society of Interventional Radiology Standards of Practice Committee.Quality Improvement Guidelines for Transjugular Intrahepatic Portosystemic Shunts.J Vasc Interv Radiol. 2016 Jan;27(1):1-7. doi:10.1016/j.jvir.2015.09.018García-Pagán JC, Saffo S, Mandorfer M, Garcia-Tsao G.Where does TIPS fit in the management of patients with cirrhosis?JHEP Rep. 2020 May 23;2(4):100122. doi:10.1016/j.jhepr.2020.100122Luo L, Fu S, Zhang Y, Wang J.Early diet intervention to reduce the incidence of hepatic encephalopathy in cirrhosis patients: post-Transjugular Intrahepatic Portosystemic Shunt (TIPS) findings.Asia Pac J Clin Nutr. 2016;25(3):497-503. doi:10.6133/apjcn.092015.14MedlinePlus.Loss of brain function - liver disease.
MedlinePlus.Transjugular intrahepatic portosystemic shunt (TIPS).
Dariushnia SR, Haskal ZJ, Midia M, Martin LG, Walker TG, Kalva SP, Clark TW, Ganguli S, Krishnamurthy V, Saiter CK, Nikolic B; Society of Interventional Radiology Standards of Practice Committee.Quality Improvement Guidelines for Transjugular Intrahepatic Portosystemic Shunts.J Vasc Interv Radiol. 2016 Jan;27(1):1-7. doi:10.1016/j.jvir.2015.09.018
García-Pagán JC, Saffo S, Mandorfer M, Garcia-Tsao G.Where does TIPS fit in the management of patients with cirrhosis?JHEP Rep. 2020 May 23;2(4):100122. doi:10.1016/j.jhepr.2020.100122
Luo L, Fu S, Zhang Y, Wang J.Early diet intervention to reduce the incidence of hepatic encephalopathy in cirrhosis patients: post-Transjugular Intrahepatic Portosystemic Shunt (TIPS) findings.Asia Pac J Clin Nutr. 2016;25(3):497-503. doi:10.6133/apjcn.092015.14
MedlinePlus.Loss of brain function - liver disease.
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