Transjugular intrahepatic portosystemic shunt

A transjugular intrahepatic portosystemic shunt, also TIPS, is an artificial channel in the liver from the portal vein to a hepatic vein (for blood). It is created endovascularly (via the blood vessels) by physicians via the jugular vein.

It is used to treat portal hypertension (which often is due to scarring of the liver (liver cirrhosis)) which frequently leads to intestinal bleeding (esophageal varices) or the buildup of fluid within the abdomen (ascites).

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Mechanism of action

A TIPS decreases the effective vascular resistance of the liver. The result is a reduced pressure drop over the liver and a decreased portal venous pressure. This, in turn, lessens the pressure on the blood vessels in the intestine so that future bleeding is less likely to occur. The reduced pressure also makes less fluid develop, although this benefit may take weeks or months to occur.

Implantation

Transjugular intrahepatic portosystemic shunts are typically placed by interventional radiologists under fluoroscopic guidance.^[1] Access to the liver, as the name transjugular suggests, is gained via the jugular vein in the neck. Once access to the jugular vein is confirmed, a guidewire and introducer sheath is typically placed to facilitate the shunt's placement. This enables the interventional radiologist to gain access to the patient's liver vein (hepatic vein) by passing through the heart. The shunt is created by advancing a special needle through the sheath system to connect the hepatic vein to the large vein near the center of the liver, the portal vein. The channel for the shunt is next created by inflating an angioplasty balloon within the liver along the tract of created by the needle. The shunt is completed by placing a special mesh tube known as a stent or endograft to establish the connection between the high pressure portal vein with the lower pressure hepatic vein. After the procedure, fluoroscopic images are made to show placement and pressure measurements in the portal vein and inferior vena cava are often done.

Use in hepatorenal syndrome

TIPS has shown some promise for patients with hepatorenal syndrome.^[2]

Complications

A complication of umbilical hernia has been recently reported.^[3]

See also

• Portal venous system
• Distal splenorenal shunt procedure
• Interventional radiology

References

1. ^ What You Need to Know about the Transjugular Intrahepatic Portosystemic Shunt (TIPS). Cleveland Clinic. URL: http://www.clevelandclinic.org/health/health-info/docs/0200/0237.asp?index=4956. Accessed: February 19, 2007.
2. ^ Guevara M, Rodes J. Hepatorenal syndrome. Int J Biochem Cell Biol. 2005 Jan;37(1):22-6. PMID 15381144.
3. ^ Mallavarapu RK, Grimsley EW (2007). "Incarcerated umbilical hernia after transjugular intrahepatic portosystemic shunt procedure for refractory ascites". Clin. Gastroenterol. Hepatol. 5 (9): A26. doi:10.1016/j.cgh.2007.07.018. PMID 17825762.

• Transjugular Intrahepatic Portosystemic Shunt - eMedicine.com.
• A schematic representation of a TIPS - University of Michigan.