Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Transjugular intrahepatic portosystemic shunt or (TIPS) is a shunt (tube) placed between the portal vein which carries blood from the intestines and intraabdominal organs to the liver and the hepatic vein which carries blood from the liver back to the vena cava and the heart.
For what is TIPS used?
It is used primarily (but not exclusively) in patients with cirrhosis in which the scar tissue within the liver causes partial blockage of flow of blood passing through the liver from the portal vein to the hepatic vein. The blockage increases the pressure in the portal vein, which is called portal hypertension. As a result of the increase in pressure, portal blood flows preferentially through the branches of the portal vein to veins coming from abdominal organs that normally drain into the portal vein. These organs connect with veins that do not empty into the portal vein and thus bypass the liver. Thus, much of the flow of blood bypasses the liver. If these veins going to the other organs enlarge, they are referred to as variceal veins or varices. Unfortunately, one of the places varices form is in the stomach and lower esophagus, and these varices have a tendency to bleed massively, frequently causing death from exsanguination. By providing an artificial path for blood traveling from the intestines, through, the liver, and back to the hear, the shunt placed during the TIPS procedure reduces the pressure in the portal vein, preventing varices from forming.
How is TIPS performed?
Unfortunately, one of the places varices form is in the stomach and lower esophagus, and these varices have a tendency to bleed massively, frequently causing death from exsanguination. By providing an artificial path for blood traveling from the intestines, through the liver, and back to the heart, the shunt placed during the TIPS procedure reduces the pressure in the portal vein, preventing varices from forming.
There are several types of portosystemic shunts that are placed surgically, but TIPS is a non-surgical method of placing a portosystemic shunt. The shunt is passed down the jugular vein from the neck by a radiologist using X-ray guidance. The shunt then is inserted between the portal and hepatic veins within the liver.
There are two important complications of the TIPS procedure. The first is hepatic encephalopathy, a condition in which it is believed that toxic products from the intestines (for example, ammonia) that are normally removed from the blood by the liver remain in the blood and are delivered to the brain. (The TIPS allows the toxin-containing blood to bypass the liver.) The effects on the brain can vary from minor alterations in thinking to full coma.
A second complication is heart failure due to the sudden increase in the amount of blood returning to the heart through the shunt. The heart is unable to pump the returning blood fast enough, resulting in heart failure.
Finally, one complication may be caused by the shunt itself; problems such as
infection and shunt occlusion, requiring placement of another shunt.
Medically reviewed by Venkatachala Mohan, MD; Board Certified Internal Medicine with subspecialty in Gastroenterology
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