The transjugular intrahepatic portosystemic shunt, commonly called the TIPS procedure, is done to treat portal hypertension, wherein a shunt is placed between the portal and hepatic veins.
The liver is the largest gland in the body. It is the main organ involved with hydrolyzation of fats and removal of toxins, among other functions. To carry out all these functions, the liver needs a very rich blood supply. When liver diseases like liver cirrhosis affect a person, there is scarring of the liver tissue. This leads to obstruction of normal blood flow to the liver. There is an increase in the blood pressure in the main vein of the liver, which leads to portal hypertension. One of the ways to treat portal hypertension is with the help of a TIPS procedure.
Why is it Needed?
TIPS is basically a shunt, or tube, that is placed between two main veins:
- The hepatic portal vein, which carries blood from the organs of the abdomen and intestines, to the liver and;
- The hepatic vein, which takes the blood from the liver, and puts it back into systemic circulation in the vena cava veins.
When there is scarring of the liver, it leads to blockage of blood flow in these veins. Thus, the blood, trying to find a way out, builds up in the portal vein. It then flows from its branches into the other organs of the abdomen. There are two detrimental effects of this–firstly, the blood ends up bypassing the liver, so the liver does not get as much blood as it needs; and secondly, it leads to enlargement of veins that supply blood to organs of the abdomen. This enlargement of other veins may be severe enough to rupture the veins, which in turn, may lead to massive bleeding in the abdominal region, even leading to death. To avoid all this, a transjugular intrahepatic portosystemic shunt or a tube is placed, so as to mediate and help in the normal flow of blood to the liver and aid in resumption of liver function.
How is the Procedure Performed?
This medical procedure is performed by a qualified interventional radiologist. It is done with the help of a fluoroscopic light. The liver is accessed via the jugular vein in the region of the neck. When the entry into the jugular vein is established, a thin guidewire and sheath are introduced, so as to help in the placement of the TIPS. Access to the patient’s hepatic vein is obtained slowly, by following a path through the vena cava. The basic shunt is made by passing a needle, so as to set up a connection between the hepatic and the portal vein. Then, an angioplasty balloon is inflated in this region, so as to secure the network established. Finally, a stent is placed to maintain the connection between the portal and hepatic veins.
There are a few possible complications associated with the TIPS procedure. The first and major possible risk is what is known as hepatic encephalopathy. This is a condition where toxic products that come from the gastro-intestinal tract, which are otherwise filtered out by the liver, start accumulating in the blood. Due to this, they reach the brain and can hinder its normal functioning. In severe cases, it may even lead to brain damage. Another complication is the possibility of congestive heart failure, because of the sudden spurt and increase in the amount of blood that reaches the heart, due to the shunt. Thus, heart and blood pressure monitoring are extremely important when doing a TIPS procedure. Other TIPS procedure side effects include slight trauma and damage to adjacent blood vessels, infection, or fever.
Although there are a few risks involved with this procedure, it is one of the best non-invasive treatment options for dealing with a severe condition like portal hypertension.