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TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS)
A TIPS is a minimally invasive treatment for the complications of liver disease (cirrhosis) which may cause repeated gastrointestinal bleeding (varices) or accumulation of fluid in the abdomen (ascites).There are two types of veins inside the liver. The first, called the portal vein, brings blood from the intestines to the liver. The blood percolates through tiny liver vascular channels called sinusoids and then is drained by the hepatic veins back into the main bloodstream of the body.
When cirrhosis develops, scarring occurs within the liver and blood cannot pass through the sinusoids from the portal vein to the hepatic vein. When this occurs, pressure builds up in the veins in the stomach and intestines. This leads to fluid accumulation within the abdomen (ascites) and dilated veins called varices in the stomach and esophagus.
Liver disease leading to portal hypertension in the past was treated surgically. In a major operation, a bypass was created connecting the portal veins to the large veins in the abdomen which drain into the heart. This was a major operation usually performed on critically ill patients, with high rates of complications and death.
A team of Interventional Radiologists led by Josef Rosch, M.D. at Oregon Health Sciences University developed a procedure called a Transjugular Intrahepatic Portosystemic Shunt (TIPS) which could reproduce the portal vein bypass without surgery. During a TIPS procedure, a small catheter less than 4 mm in diameter is passed through the jugular vein in the neck into a hepatic vein in the liver using X-ray guidance. Through this small conduit, a connection is made between the portal vein and a vein draining the liver. A tract is formed with angioplasty and stent technigues which creates a shunt within the liver. This shunt relieves the pressure build-up within the portal vein which in turn treats the bleeding caused by abnormal blood vessels (varices) as well as the fluid accumulation in the abdomen (ascites).
The procedure is usually performed with intravenous sedation without the need to experience the risk of general anesthesia. Transjugular Intrahepatic Portosystemic Shunts (TIPS) are as effective as surgical shunts but much safer to undergo and have a much shorter recovery time.
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