Expert Opinion

Get A Second Opinion

The medical second opinion will be presented to you within 48 hours.
Menu
Facebook-f Twitter Linkedin-in Google

TIPS Procedure (Transjugular Intrahepatic Portosystemic Shunt)

TIPS Procedure (Transjugular Intrahepatic Portosystemic Shunt)

TIPS, or Transjugular Intrahepatic Portosystemic Shunt procedure, is a sophisticated interventional procedure. The treatment is performed by a physician experienced in interventional radiology. It is used especially in the treatment of chronic liver diseases. With this method, a path is created between the portal and hepatic veins in the liver. It is applied in gastric variceal bleeding and excessive fluid accumulation in the abdomen that cannot be corrected with medical treatment.

What Is the TIPS Procedure?

Transjugular Intrahepatic Portosystemic Shunt (TIPS) is a minimally invasive radiologic intervention that establishes an artificial conduit within the liver between the portal vein and a hepatic vein, effectively creating a portosystemic shunt.

It is primarily used to reduce portal venous pressure in patients suffering from complications of portal hypertension, most commonly due to cirrhosis. The procedure is often a last-line treatment before liver transplantation.

Pathophysiology: Why Is TIPS Needed?

Portal hypertension results from increased resistance to blood flow through the liver, typically caused by fibrosis, inflammation, or nodular regeneration in cirrhosis. This increased pressure leads to the development of:

  • Esophageal and gastric varices (prone to life-threatening bleeding)

  • Refractory ascites

  • Hepatic hydrothorax

  • Hepatorenal syndrome

TIPS alleviates the pressure by redirecting blood flow through a stent, bypassing the diseased hepatic parenchyma, and reducing the risk of rupture in varices and improving sodium and water retention.

Clinical Indications for TIPS

According to current clinical guidelines (AASLD, EASL), TIPS is indicated for:

  • Recurrent variceal hemorrhage unresponsive to endoscopic and pharmacologic therapy

  • Refractory ascites (despite maximal diuretic therapy and paracentesis)

  • Hepatic hydrothorax resistant to medical management

  • Budd-Chiari syndrome (as a decompression method)

  • Portal vein thrombosis with cavernoma

  • Bridge to liver transplant (when MELD is high and complications are rising)

Procedure Details: How TIPS Is Performed

Performed by an interventional radiologist, TIPS is conducted under fluoroscopic guidance and typically requires conscious sedation or general anesthesia.

Step-by-Step Process:

  1. Access via right internal jugular vein.

  2. Catheter navigated into the hepatic vein using fluoroscopy.

  3. Needle punctures hepatic parenchyma to access the portal vein.

  4. A metallic stent (usually PTFE-covered) is placed across the tract, creating a low-resistance channel.

  5. Portal pressures are measured pre- and post-placement to confirm efficacy (goal: <12 mmHg portal pressure gradient).

⏱ Procedure Time: ~1.5 to 3 hours
🏨 Hospital Stay: Typically 1–2 days

Efficacy and Outcomes

  • Variceal Bleeding Control: >90% immediate control

  • Ascites Management: ~60–70% long-term improvement

  • Bridge to Liver Transplant: Effective in stabilizing MELD and managing complications

Note: Long-term patency of the stent is a concern, with 25–40% requiring revision within 12 months.

Risks and Complications

  • Despite its minimally invasive nature, TIPS has notable risks:

    Complication Description
    Hepatic Encephalopathy Occurs in 30–40% due to bypassing liver detoxification
    Stent dysfunction or thrombosis Can lead to recurrence of symptoms
    Heart failure Risk in patients with pre-existing cardiac dysfunction due to increased preload
    Infection or sepsis Rare, but possible
    Liver failure Especially in patients with very advanced cirrhosis

    Contraindications include:

    • Severe hepatic encephalopathy

    • Congestive heart failure

    • Uncontrolled systemic infection

    • Severe pulmonary hypertension

    • Advanced Child-Pugh C or MELD >25 (depending on center policy)

Pre-Procedural Workup

Before undergoing TIPS, patients typically require:

  • Doppler ultrasound of the liver

  • CT or MRI to evaluate hepatic vasculature

  • Cardiac assessment (Echocardiography)

  • Lab panel: CBC, LFTs, INR, Creatinine, and MELD score calculation

Post-Procedure Follow-Up and Monitoring

  • Doppler ultrasound at 1 day, 1 month, then every 3–6 months

  • Ammonia levels and neuro checks to monitor for encephalopathy

  • Lactulose or rifaximin prescribed prophylactically if encephalopathy occurs

Shunt patency is critical. Any signs of recurrence of ascites, variceal bleeding, or encephalopathy warrant immediate imaging and possible shunt revision.

Conclusion: Is TIPS Right for You?

  • The TIPS procedure is a powerful, life-extending intervention for patients with decompensated cirrhosis and portal hypertension complications. It buys time, improves quality of life, and often serves as the bridge to a definitive liver transplant.

    Talk to your hepatologist or liver specialist to understand your candidacy and explore all options.