Transjugular intrahepatic portosystemic shunt (TIPS)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.DescriptionThis is not a surgical procedure. It 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 anesthesia and medicine to relax you. This will make you pain-free and sleepy. Or, you may have general anesthesia (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 the Procedure is PerformedNormally, 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).Common causes of portal hypertension are:Alcohol abuseBlood clots in a vein that flows from the liver to the heartToo much iron in the liver (hemochromatosis)Viral hepatitis (hepatitis B or hepatitis C)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.RisksPossible risks with this procedure are:Damage to blood vesselsFeverHepatic encephalopathy (a disorder that affects concentration, mental function, and memory, and may lead to coma)Infection, bruising, or bleedingReactions to medicines or the contrast dyeStiffness, bruising, or soreness in the neckRare risks are:Bleeding in the bellyBlockage in the stentCutting of blood vessels in the liverHeart problems or abnormal heart rhythmsInfection of the stentBefore the ProcedureYour doctor may ask you to have these tests:Blood tests (complete blood count, electrolytes, and kidney tests)Chest x-ray or EKGAlways tell your doctor or nurse:If you are or could be pregnantAny drugs you are taking, even drugs, 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 the ProcedureAfter 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.