ટ્રાન્સજયુગ્યુલર ઈન્ટ્રાહેપેટીક પોર્ટો સીસ્ટેમીક શન્ટ (ટી.આઈ

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During a TIPS procedure, interventional radiologists use image guidance to make a tunnel through the liver to connect the portal vein (the vein that carries blood from the digestive organs to the liver) to one of the hepatic veins (three veins that carry blood away from the liver back to the heart). A stent is then placed in this tunnel to keep the pathway open. 

Patients who typically need a TIPS have portal hypertension meaning they have increased pressure in the portal vein system. Portal hypertension is secondary to LIVER DISEASE. This pressure buildup can cause blood to flow backward from the liver into the veins of the spleen, stomach, lower oesophagus, and intestines, causing enlarged vessels, bleeding and the accumulation of fluid in the chest or abdomen.  

A TIPS is used to treat the complications of portal hypertension, including: 

• Variceal bleeding, bleeding from any of the veins that normally drain the stomach, oesophagus, or intestines into the liver. 
• Portal gastropathy, an engorgement of the veins in the wall of the stomach, which can cause severe bleeding. 
• Severe ascites (the accumulation of fluid in the abdomen) and/or hydrothorax (in the chest). 
• Budd-Chiari syndrome, a blockage in one or more veins that carry blood from the liver back to the heart. 

A TIPS reroutes blood flow in the liver and reduces abnormally high blood pressure in the veins of the stomach, oesophagus, bowel and liver, reducing the risk of bleeding from enlarged veins across the oesophagus and stomach. 

• Through a vein in right side of neck, a catheter is negotiated toward the liver and into one of the hepatic veins. 
• Pressures are measured in the hepatic vein and right heart to confirm the diagnosis of portal hypertension, and also to determine the severity of the condition.
• Access is then gained from the hepatic vein into the portal system using a TIPS needle (a special long needle extending from the neck into the liver). 
• A stent is then placed under fluoroscopy extending from the portal vein into the hepatic vein. 
• Once the stent is in the correct position, the balloon is inflated, expanding the stent into place. 
• This procedure is usually completed in two hour’s time but may take up to several hours depending on the complexity of the condition and vascular anatomy. 

Benefits 

• Studies have shown that this procedure is successful in reducing variceal bleeding, fluid accumulation in abdomen and chest in more than 90 percent of patients. 
• TIPS is a minimally invasive procedure that typically has a shorter recovery time. 
• TIPS should have less of an effect than open surgical bypass on future liver transplantation surgery if needed because the abdomen has not been entered, thus there is no scar tissue formed in the abdomen. 

Risks (2-5%)

• Abdominal bleeding that might require a transfusion. 
• Encephalopathy: can lead to confusion .The TIPS may cause too much of these substances to bypass the liver, so a patient who already has encephalopathy because of their liver disease may not be a good candidate for the procedure.
• Encephalopathy can be treated with certain medications, a special diet or, by revising the stent.