Portal Hypertension (cont.)
What Tests Are Required Before the TIPS and DSRS Procedures
Before receiving either of these procedures for portal hypertension, the following tests may be performed to determine the extent and severity of your condition:
- Evaluation of your medical history
- A physical examination
- Blood tests
- Angiogram (an X-ray test that takes pictures of the blood flow within a particular artery)
- Ultrasound
- Endoscopy
Before either the TIPS or DSRS procedure, your doctor may ask you to have other preoperative tests, which may include an electrocardiogram (EKG) (a test that records the electrical activity of your heart), chest X-ray, or additional blood tests. If your doctor thinks you will need additional blood products (such as plasma), they will be ordered at this time.
What Happens in the TIPS Procedure?
During the TIPS procedure, a radiologist makes a tunnel through the liver with a needle, connecting the portal vein to one of the hepatic veins (veins connected to the liver). A metal stent often covered with a thin plastic material, is placed in this tunnel to keep the tunnel open.
The procedure reroutes blood flow in the liver and reduces pressure in all abnormal veins, not only in the stomach and esophagus, but also in the bowel and the liver.
This is not surgery. The radiologist performs the procedure within the vessels under X-ray guidance. The process lasts one to three hours, but you should expect to stay in the hospital overnight after the procedure.
How Successful Is the TIPS Procedure?
The TIPS procedure controls bleeding immediately in more than 90% of patients with portal hypertension. However, in about 20% of patients, the shunt may narrow, causing varices to re-bleed at a later time.
What Complications Are Associated With TIPS?
Shunt narrowing or blockage can occur within the first year after the TIPS procedure. Follow-up ultrasound examinations are performed frequently after the TIPS procedure to detect these complications. The signs of a blockage include increased ascites (accumulation of fluid in the abdomen) and re-bleeding. This condition can be treated by a radiologist who re-expands the shunt with a balloon or repeats the procedure to place a new stent.
Encephalopathy, or abnormal functioning of the brain, can occur with severe liver disease. Hepatic encephalopathy can become worse when blood flow to the liver is reduced by TIPS, which may result in toxic substances reaching the brain without being metabolized first by the liver. This condition can be treated with medications, diet, or by making the shunt inaccessible.
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