Transjugular Intrahepatic Porto-Systemic shunt

Answer 1

I will answer this question in sections, as I have done extensive research on this, as my husband is going to be possibly be having this procedure.

The "Trans-Jugular Intrahepatic Portosystemic Shunt", or the "TIPPS PROCEDURE", is done by an Interventional Radiologist. This simply means it is done by a Radiologist that is trained to do various procedures with the assistance of some type of device, and in this case, a Fluoroscope is utilized.

The procedure is done for multiple reasons, but in my husband's case, it will be done because he has End Stage Liver Failure, with Stage 4 Cirrhosis, (which is essentially scarring of the liver tissue), and ascites (fluid that builds up in the abdominal cavity), because the liver cannot filter it out due to all of this scarring and damage.

This results in ESLF Patients having to have "paracentesis" procedures done frequently, to drain such fluid, as it can cause a host of complications if left in the abdominal cavity.

The theory goes that this procedure will , over a period of days or even months, help to keep this ascites fluid from collecting in the abdominal cavity, and increase blood flow to the liver.

There are several complications , however, and though the procedure is decidedly pain free, the patient is watched carefully after the procedure for signs of bleeding, and increased confusion, or "Hepatic Encephalopathy" which occurs in one out of three patients who have this procedure. This condition occurs when toxins from the liver's inability to process fluids build up, (ascites fluid is an example) and goes directly to the brain, causing cognitive and functional impairment, including confusion, drowsiness, and sometimes a coma.

When this occurs, it is reversible, and medications are utilized to reverse the condition.

(The average hospitalization time for a patient who does not have any complications from the procedure is three days)

The TIPPS procedure can also cause the End Stage Liver Failure patent's MELD score to significantly rise, and this is a scoring system put forth by the Federally funded (USA) UNOS Program, for the purpose of evaluating in a fair and concise fashion who needs a liver transplant the soonest, who is the sickest. When the "MELD" (Model for End Stage Liver Disease) Score rises, it does put the patient higher up on the list, but the hazard is that there might not BE a liver available when it is most needed.

It is, unfortunately, (in this humble writer's opinion) as with most transplants, a game of pros and cons.

The PROS of this procedure are (hopefully) the following:

1. reduced pressure drop over the liver

2. decreased PORTAL VENOUS PRESSURE

3. decreases the effective vascular resistance of the liver.

4. lessens the pressure on the blood vessels in the intestine so that future bleeding is less likely to occur. Reduced pressure also makes less fluid develop

IMPORTANT WORDS TO KNOW ABOUT THIS PROCEDURE: REFERENCE: www.wordsreference.com)

SHUNT- shunt. implant consisting of a tube made of plastic or rubber; for draining fluids within the body

SHEATH- an enveloping structure or covering, enclosing an animal or plant organ or part

STENT-a device placed in a body structure, (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open

The procedure is done by gaining Intravenous access to the Jugular Vein of the neck

. Once access is confirmed, a guide-wire and an introducer "sheath" are inserted,placed to help the shunt's placement. This helps the radiologist gain access to the Hepatic Vein, by going through the Vena Cava. (simply put, the "Vena Cava" is a vein that is attached to the heart)

The "Shunt" is created by advancing a special needle through the "sheath system" to connect the Hepatic Vein to the large Portal Vein, which is 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 special needle.

The "shunt" is completed by placing a special mesh tube known as a "stent", or "endograft".to maintain the tract to the Portal Vein which has the higher pressure, and the Hepatic Vein, which has the lower pressure.

After the procedure, the Interventional Radiologist takes fluoroscope pictures to show proper placement.

*This is not a complete answer to what this procedure involves, and it needs extensive editing. I look forward to this editing by professionals , of which I am not.

This is only the result of several days of research I have conducted, along with the words of our Transplant Physician.