Transjugular Intrahepatic Portosystemic Shunt
What you should know
A transjugular intrahepatic portosystemic shunt (TIPS) is a channel that is made inside your liver to increase blood flow. This shunt reduces swelling in your abdomen, and portal hypertension. Portal hypertension is high blood pressure in the vein that carries blood to your liver. It is caused by scar tissue in your damaged liver that will not allow the blood to flow through it. TIPS may reduce blood pressure near your liver, or stop bleeding in your esophagus. TIPS may also reduce fluid buildup in your abdomen.
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- Rarely, a blood vessel or organ may be damaged during the procedure. This may cause bleeding inside your body. After your procedure, the stent could narrow and cause blood clots to form inside the stent. This may block blood flow, or increase blood pressure in your veins. The stent may move out of place or stiffen and stop working. You may also be at risk for a blood infection called sepsis. You may have new or worsened encephalopathy after your procedure. Encephalopathy is brain damage that causes mood and behavior changes. Your procedure may not reduce your portal hypertension. This may mean the bleeding in your esophagus and swelling in your abdomen may not stop. These problems may be life-threatening.
- You may need to receive another TIPS procedure if your stent has slipped or is not working. You may also need another TIPS procedure if the stent does not reduce your portal hypertension or other symptoms. You may have heart failure from the increased blood flow to your heart after your procedure. This procedure may not improve your chance for survival. The TIPS procedure may cause liver failure. You may still need a liver transplant after a TIPS procedure. You may have skin damage from the radiation in all your screening tests. Your condition may worsen, or you could die without a TIPS procedure.
Before your procedure:
- You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.
- Tell your caregiver if you have any blood clotting problems or if you use medicine to thin your blood.
- Ask your caregiver if you need to stop using aspirin or other medicine before your procedure. Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell him if you use any herbs, food supplements, or over-the-counter medicines.
- You may need to take an antibiotic medicine before your procedure. This medicine helps prevent or fight an infection caused by bacteria.
- You may need a liver ultrasound, MRI, or CT scan. You may be given dye called contrast to help the pictures show up better. Tell the caregiver if you are allergic to iodine or seafood. You may also be allergic to the dye. Write down the date, time, and location of each test.
The night before your procedure:
Ask caregivers about directions for eating and drinking.
The day of your procedure:
An anesthesiologist will talk to you before your surgery. You may need medicine to keep you asleep or numb an area of your body during surgery. Tell caregivers if you or anyone in your family has had a problem with anesthesia in the past.
What will happen:
- Your caregiver may give you anesthesia that keeps you awake, but not aware of what is happening. You may receive stronger, general anesthesia to make you sleep during the procedure.
- Your caregiver will insert a needle into the vein in your neck. Then he will insert a catheter into your vein. The catheter will have a small balloon attached to it. He will push the catheter, stent (tube), and balloon through the neck vein, down into your liver. He may also check the blood pressure in your veins with the inflated balloon. He will use the inflated balloon to make a channel in your liver. He will insert the stent into the channel.
- Your caregiver may do a procedure to stop your esophagus from bleeding before or after the TIPS placement. He will then place a bandage on the small wound on your neck.
After your procedure:
You will be taken to a room where you can rest until you wake up. You will be taken to your room if you are staying at the hospital. Do not get out of bed until your caregiver says it is OK. Your family and friends can wait in the waiting room until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area. Your caregiver may give you another ultrasound after procedure to see how well your stent is working. He may also need to do a test called a venogram to check blood flow through the veins in your liver.
Contact a caregiver if
- You cannot be at your procedure on time.
- You get sick with a cold or the flu.
- You have questions or concerns about your procedure.
Seek Care Immediately if
- You have worsened swelling in your abdomen.
- You have worsened bleeding in your esophagus, or you are coughing up blood.
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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.