Name of the Procedure:

Insertion of Transvenous Intrahepatic Portosystemic Shunt(s) (TIPS)

Summary

The TIPS procedure is a minimally invasive method used to create a new route for blood flow in the liver. It involves placing a shunt (a small tube) between the portal vein, which carries blood from the intestines to the liver, and a hepatic vein, which drains blood from the liver to the heart. The procedure helps improve blood flow and reduce high blood pressure in the portal vein, a condition known as portal hypertension.

Purpose

TIPS is primarily used to manage complications arising from portal hypertension, such as variceal bleeding (bleeding from veins in the esophagus or stomach), refractory ascites (accumulation of fluid in the abdomen), and hepatorenal syndrome (kidney failure due to liver disease). The goal is to decrease the pressure in the portal vein to prevent complications and improve symptoms.

Indications

• Severe portal hypertension.
• Variceal bleeding that is resistant to other treatments.
• Refractory ascites not relieved by diuretics.
• Hepatorenal syndrome.
• Cirrhosis with complications from portal hypertension.

Preparation

• Patients may be instructed to fast for 6-8 hours before the procedure.
• Adjustments might be needed for certain medications, especially blood thinners.
• Pre-procedure tests may include blood tests, imaging studies like ultrasound or CT scans, and assessments of liver and kidney function.

Procedure Description

1. Venous access is established, often through the jugular vein in the neck.
2. A catheter is threaded through veins to reach the hepatic and portal veins in the liver.
3. Portography is performed to visualize blood flow and measure pressures within the veins.
4. A needle creates a small tract through the liver tissue connecting the portal vein to a hepatic vein.
5. The tract is dilated (widened), and a stent (a small tube) is placed to keep it open.
6. Continuous imaging guides the placement and ensures precise positioning.
7. Final hemodynamic evaluation confirms the functional effectiveness of the shunt.

Duration

The procedure typically takes 1-3 hours.

Setting

The TIPS procedure is performed in a hospital, specifically in an interventional radiology suite or an operating room equipped for image-guided interventions.

Personnel

• Interventional radiologist or a specialized surgeon.
• Radiology technologists.
• Nurses.
• Anesthesiologist or sedation nurse (if sedation or general anesthesia is used).

Risks and Complications

• Bleeding or hemorrhage.
• Infection.
• Stent dysfunction or occlusion.
• Liver function deterioration.
• Encephalopathy (confusion or altered mental status due to liver dysfunction).
• Rare complications include shunt migration or damage to surrounding organs.

Benefits

• Reduction in portal hypertension and its complications.
• Improvement in symptoms like ascites and variceal bleeding.
• Enhanced quality of life.
• Benefits may be seen relatively quickly, often within days to weeks.

Recovery

• Short hospital stay, typically 1-2 days.
• Monitoring for any immediate complications.
• Follow-up imaging to ensure the stent is functioning properly.
• Gradual return to normal activities as advised by the healthcare provider.

Alternatives

• Medical management with medications.
• Endoscopic procedures to control variceal bleeding.
• Liver transplant in cases of advanced liver disease.
• Bottom line: Alternatives might be less effective or suitable based on the patient's condition.

Patient Experience

• During the procedure: Sedation or anesthesia helps minimize discomfort. Some pressure or mild pain might be felt.
• After the procedure: Mild to moderate pain at the access site, managed with pain relief medications.
• Follow-up includes frequent monitoring and imaging to ensure the shunt remains functional.