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Transjugular Intrahepatic Portosystemic Shunt
WHAT YOU NEED TO 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.
WHILE YOU ARE HERE:
Before your procedure:
- Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
- An IV is a small tube placed in your vein that is used to give you medicine or liquids.
- Vital signs: Healthcare providers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. Vital signs give information about your current health.
- Anesthesia: This medicine is given to make you comfortable. You may not feel discomfort, pressure, or pain. An adult will need to drive you home and should stay with you for 24 hours. Ask your healthcare provider if you can drive or use machinery within 24 hours. Also ask if and when you can drink alcohol or use over-the-counter medicine. You may not want to make important decisions until 24 hours have passed.
- Medicine may be given to keep you awake during the procedure, but not aware of what is happening. You may receive general anesthesia to make you sleep during your procedure. You may get anesthesia through your IV or as a gas through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
During your procedure:
- Your healthcare provider will clean the right side of your neck to help prevent infection. He will insert a needle into your neck, and push it into your jugular vein. Your jugular vein is a main vein in your neck that helps drain blood from your head. It leads all they way down to your liver. Your healthcare provider will only open the vein wide enough to insert a small catheter and stent (tube) into it. The stent is the covered tube that will be placed in your liver to create the path between the 2 main veins. Your healthcare provider will inject dye and use x-rays, an ultrasound, or venography as a guide to know where to place the catheter.
- Your healthcare provider will use a small balloon attached to the catheter to measure blood pressure in your veins. Vein pressure will also show your healthcare provider where to place the TIPS inside your liver. Your healthcare provider will then insert the catheter into your liver. He will inflate the balloon once it is placed between the 2 main veins in your liver. The balloon will make a channel for the stent.
- Your healthcare provider may repair bleeding areas in your esophagus before or after the TIPS procedure. He will then place a bandage on the small wound on your neck.
After your procedure:
- You will be taken to a recovery area where healthcare providers will watch you until you are alert. Your heart and breathing will be monitored. Do not get out of bed until your healthcare provider says it is okay.
- Waiting area: This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.
- You may need an ultrasound 2 to 3 days after your procedure to make sure the stent and shunt are working well. He may also need to do a test called a venogram to check blood flow through the veins in your liver. You will need another ultrasound 1 to 4 weeks after your procedure.
Preventing blood clots:
Around the time of your surgery or procedure you may need to take medicine to thin your blood. Blood thinning medicine helps prevent blood clots from forming in your veins. This medicine makes it easier for a person to bruise and bleed. You will need regular blood tests while taking this medicine. If you have a bleeding disorder or a history of bleeding or blood clots, tell your healthcare provider. Talk to your provider about all of the medicines you use. Physical activity helps prevent blood clots. Healthcare providers will help you be as active as possible after your surgery or procedure.
- 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.
CARE AGREEMENT:You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment.
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