Name of the Procedure:

Revision of Transvenous Intrahepatic Portosystemic Shunt (TIPS) Common terms include: TIPS revision, transjugular intrahepatic portosystemic shunt revision

Summary

A TIPS revision involves modifying an existing conduit between the portal and hepatic veins in the liver, aimed at improving blood flow and reducing complications associated with liver disease.

Purpose

This procedure addresses complications like portal hypertension found in conditions such as cirrhosis. The goals are to relieve symptoms, reduce the risk of variceal bleeding, and decrease fluid accumulation in the abdomen.

Indications

• Recurrent or uncontrolled variceal bleeding
• Refractory ascites (fluid accumulation in the abdomen)
• Shunt dysfunction or blockage
• Symptoms indicating high portal pressure

Preparation

• Fasting for at least 8 hours prior to the procedure
• Adjustments or cessation of certain medications, as advised by the doctor
• Pre-procedure diagnostic tests such as blood tests, imaging studies, and an evaluation of liver function

Procedure Description

1. Venous Access: A catheter is inserted into a large vein, typically via the neck (jugular vein).
2. Hepatic and Portal Vein Catheterization: The catheter is guided to the liver veins.
3. Portography and Hemodynamic Evaluation: Imaging and pressure measurements assess the shunt and liver circulation.
4. Intrahepatic Tract Recannulization/Dilatation: The existing shunt is reopened or dilated.
5. Stent Placement: A stent is inserted to keep the new pathway open.
6. Completion: The catheter is removed and access site dressed.

This procedure uses fluoroscopy (a type of x-ray), catheters, guide wires, and stents. It’s typically performed under moderate sedation or general anesthesia.

Duration

Approximately 2 to 4 hours.

Setting

Performed in a hospital’s interventional radiology suite or operating room.

Personnel

• Interventional radiologist or vascular surgeon
• Nurses
• Anesthesiologist
• Radiologic technologists

Risks and Complications

• Bleeding
• Infection
• Shunt blockage or dysfunction
• Organ injury
• Allergic reaction to contrast dye
• Heart problems

Benefits

• Relief from symptoms of portal hypertension
• Reduced risk of variceal bleeding
• Improved liver function and quality of life
• Benefits usually become noticeable within a few days to a week post-procedure.

Recovery

• Monitoring in a recovery area or ICU for a day or two
• Gradual return to normal activities over a week
• Follow-up imaging and consultations to ensure shunt function
• Instructions on managing potential symptoms and when to seek medical help

Alternatives

• Medication therapy
• Surgical shunts
• Liver transplantation
• Each alternative has its own set of risks and benefits, and suitability depends on individual patient conditions.

Patient Experience

Patients may experience mild discomfort at the insertion site and some soreness. Sedation or anesthesia ensures minimal awareness during the procedure. Post-procedure, pain management includes medications as needed. Patients are encouraged to report any new or worsening symptoms promptly.