TIPS to treat liver problems
Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure to create new connections between two blood vessels in your liver. You may need this procedure if you have severe liver problems.
This is a surgical procedure but is done by a radiologist using x-ray. A radiologist is a doctor who uses imaging techniques to diagnose and treat diseases.
You will be asked to lie on your back. You will be connected to monitors that will check your heart rate and blood pressure.
You will probably receive local anaesthesia and medicine to relax you. This will make you pain-free and sleepy. Or, you may have general anaesthesia (asleep and pain-free).
Your radiologist will insert a catheter (a flexible tube) through your skin into a vein in your neck.
On the end of the catheter is a balloon and a metal mesh stent (tube).
Using x-ray equipment, your radiologist will guide the catheter into a vein in your liver.
The balloon will be blown up to place the stent. You may feel a little pain when this happens.
Your radiologist will use the stent to connect your portal vein to one of your hepatic veins.
At the end of the procedure, your portal vein pressure will be measured to make sure it has gone down.
After the procedure, a small bandage is placed over the neck area. There are usually no stitches.
The procedure takes about 60 – 90 minutes to complete.
This new pathway will allow blood to flow better. It will ease pressure on the veins of your stomach, esophagus, intestines, and liver.
Why is it done
Normally, blood coming from your esophagus, stomach, and intestines first flows through the liver. When your liver has a lot of damage and there are blockages, blood cannot flow through it very easily. This is called portal hypertension (increased pressure and backup of the portal vein). The veins can then break open (rupture), causing serious bleeding, especially into the esophagus and the stomach.
Causes of portal hypertension are:
Cirrhosis of the liver ( eg with chronic alcohol abuse, hepatitis B or hepatitis C)
Blood clots in a vein that flows from the liver to the heart
When portal hypertension occurs, you may have:
Bleeding from veins of the stomach, esophagus, or intestines (variceal bleeding)
Buildup of fluid in the belly (ascites)
Buildup of fluid in the chest (hydrothorax)
This procedure allows your blood to flow better in your liver, stomach, esophagus, and intestines, and then back to your heart. TIPS procedure is also used to treat severe ascites, which could also improve the kidney functions of the patient.
Risks
Possible risks with this procedure are:
Damage to blood vessels
Fever
Hepatic encephalopathy (a disorder that affects concentration, mental function, and memory, and may lead to coma)
Infection, bruising, or bleeding
Reactions to medicines or the contrast dye
Stiffness, bruising, or soreness in the neck
Rare risks are:
Bleeding in the belly
Blockage in the stent
Cutting of blood vessels in the liver
Heart problems or abnormal heart rhythms
Infection of the stent
Before the procedure
Your doctor may ask you to have these tests:
Blood tests (complete blood count, electrolytes, blood clotting and kidney tests)
Chest x-ray or ECG
Always tell your doctor or nurse:
If you are or could be pregnant
Any drugs you are taking, even supplements, or herbs you bought without a prescription (your doctor may ask you to stop taking blood thinners like aspirin, heparin, or warfarin a few days before the procedure)
On the day of your procedure:
Do not eat or drink anything after midnight the night before the procedure.
Ask your doctor which medications you should still take on the day of the procedure. Take these drugs with a small sip of water.
Take a shower the night before or the morning of the procedure.
Your doctor or nurse will tell you when to arrive at the hospital.
You should plan to stay overnight at the hospital.
After
After the procedure, you will recover in your hospital room. You will be monitored for bleeding. You will have to keep your head raised.
There is usually no pain after the procedure.
You will be able to go home when you feel better. This may be the day after the procedure.
Many people get back to their everyday activities in 7 to 10 days.
Your doctor will probably do an ultrasound after the procedure to make sure the stent is working correctly.
You will be asked to have a repeat ultrasound in a few weeks to make sure that the TIPS procedure is working.
Outlook (Prognosis)
Your radiologist can tell you right away how well the procedure worked. Most patients recover well.
TIPS works in about 80% – 90% of portal hypertension cases.
The procedure is much safer than surgery and does not involve any cutting or stitches.
The writer is Consultant Physician, Police Hospital Colombo