Transjugular intrahepatic portosystemic shunt

Intervention: Transjugular intrahepatic portosystemic shunt
Fluoroscopic image of TIPS in progress. A catheter has been passed into the hepatic vein and after needle puncture, a guidewire was passed into a portal vein branch. The tract was dilated with a balloon, and contrast injected. A self-expandable metallic stent has yet to be placed over the wire.
ICD-10 code:
ICD-9 code:	39.1
Other codes:

A transjugular intrahepatic portosystemic shunt (commonly abbreviated as TIPS or TIPSS) 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).

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 are typically placed to facilitate the shunt's placement. This enables the interventional radiologist to gain access to the patient's hepatic vein via the vena cava. The shunt is created by advancing a special needle through the sheath system to connect the hepatic vein to the large portal vein, near the center of the liver. The channel for the shunt is next created by inflating an angioplasty balloon within the liver along the tract created by the needle. The shunt is completed by placing a special mesh tube known as a stent or endograft to maintain the tract between the higher pressure portal vein and the lower pressure hepatic vein. After the procedure, fluoroscopic images are made to show placement. 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. http://www.clevelandclinic.org/health/health-info/docs/0200/0237.asp?index=4956. 
2. ^ Guevara M, Rodés J (2005). "Hepatorenal syndrome". Int. J. Biochem. Cell Biol. 37 (1): 22–6. doi:10.1016/j.biocel.2004.06.007. PMID 15381144. http://linkinghub.elsevier.com/retrieve/pii/S1357272504002444. 
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. 

External links

• RadiologyInfo: Transjugular Intrahepatic Portosystemic Shunt (TIPS)

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