FAQs on TIPSS(Transjugular Intrahepatic Portasystemic Stent Shunt)

Q- What Is TIPSS?

Ans- TIPSS

TIPSS stands for Transjugular Intrahepatic Portasystemic Stent Shunt. This procedure

 is used to treat a condition called portal hypertension.

What is portal hypertension ?

Sometimes with liver disease, blood flow through the liver is restricted causing an

 increase in the blood pressure in and around the liver. This is called Portal Hypertension. 

This back pressure of blood can cause a network of enlarged, weak varicose veins to 

develop in the gullet or stomach. These are called varices. If one of these veins

 ruptures severe bleeding can occur resulting in vomiting of blood or passing blood in

 the form of black stools.In patients who have fluid retention due to their liver disease,

 portal hypertension can result in a build up of fluid in the abdomen. This is called ascites.

How does t.i.p.s.s. work?

TIPSS is just one way to treat portal hypertension. It involves inserting a metal mesh 

tube (stent) through the liver which joins two large veins (the portal vein and 

hepatic vein). This allows blood to flow through the liver and relieves the portal

 hypertension which causes the varices. This stent remains in place permanently.

Prior to the procedure

• A TIPSS is sometimes inserted as an 'emergency' when other forms of treatment 
• are unable to stop severe bleeding of varices. In this situation the patient is taken
• straight to the Xray department soon after their admission to hospital.
• However sometimes the procedure can be planned ahead of time. In this case, a 
• few days before the procedure you will have various blood tests, and an ultrasound 
• scan of the liver as an in-patient. Sometimes a tracing of the heart is taken.
• The medical staff will explain the procedure and potential complications and
• you will be asked to sign a consent form.
• Before the procedure, you will be asked to eat nothing for at least 4 hours although
•  you will be allowed to drink, unless a general anaesthetic is being carried out. If this is
•  the case, you will have to fast.
• On the day of the TIPSS procedure you will be asked to change into a hospital gown.
•  A needle will be inserted into a vein in your arm through which you will be given
•  antibiotics. This is to prevent infection during or after the procedure.

How is the T.I.P.S.S. inserted?

• This procedure is carried out in the X-ray department and can take between 1-2 hours.
•  You will be asked to lie on a special Xray bed where you will be attached to monitors to
•  measure your heart rate and blood pressure. Sometimes patients are required to wear 
• oxygen masks.
• You will be given sedation through the needle in your arm which will make you drowsy
•  and relaxed. Only under special circumstances is a general anaesthetic required.
• Local anaesthetic is injected around the right side of your neck (or occasionally the
•  left side) to numb the area. A thin tube, called a central line, is inserted into the neck 
• vein. The TIPSS is passed into the central line and through the veins which lead to
•  the liver under X-ray guidance. The stent is then positioned in the liver. Blood 
• pressure readings of the liver are taken to check they have returned to normal.
• Once the procedure is complete, the monitors are removed and you will be transferred
•  back to the ward. The central line in your neck may be kept in place for use on the ward.

After the procedure

Once back in the ward you should remain on bed rest until the sedation has worn

 off. During this time nurses will monitor your blood pressure and pulse at regular 

intervals. You will be able to eat and drink once you are fully awake. If the central 

line has been removed, the needle in your hand may be kept in place in order for 

a second dose of antibiotics to be given 24 hours after the procedure.

Are there any possible complications ?

TIPSS procedure is a safe procedure with a very low frequency of complications,

 but occasionally the following can occur:

• Bruising around the injection site on the neck can occur following the procedure.
• This will clear after a few days. Occasionally this can be more severe, or the site
•  can actually bleed. Very rarely the blood can collect in the neck and can interfere
•  with breathing. The nursing staff will regularly check the neck site for this reason
•  when you return to the ward.
• Occasionally the injection site or more rarely the blood can become infected.
•  To reduce this risk, antibiotics are given. • There is a small risk of some bleeding
•  in or around the liver where the stent has been inserted. You will be monitored closely
•  for signs of this following the procedure.
• Over time the TIPSS can become narrowed or even block off. This could result in 
• bleeding again. If this happens, the TIPSS can be widened or a second stent 
• inserted if necessary. For this reason regular follow-up is important.

Follow up appointments

You will be routinely followed up in a hospital out-patients clinic. As well as this it is

 important that the TIPSS is checked regularly (usually every 6 months) to make sure 

it is still functioning. This ensures the pressure does not build up within the liver causing 

the problems you experienced previously. A TIPSS check involves a similar procedure 

to the TIPSS insertion and a small tube is inserted through the neck and passed into

 the liver. Dye is injected though this tube and x-rays are taken to see if the TIPSS is

 working. Blood pressures of the liver are also taken. If the flow through the shunt is not 

sufficient and the pressures are high, the TIPSS will be widened or a new TIPSS may 

be inserted. This usually involves an overnight stay in the ward before and sometimes

 after the procedure.It is very important to inform your doctor if you have any signs

 of bleeding after your TIPSS, such as dark stools or vomiting blood. This 

could be an indication that the TIPSS is not working.