What Is a TIPS Procedure?
A transjugular intrahepatic portosystemic shunt (TIPS for short) is a procedure meant to help blood flow more easily through your liver. It’s usually done to treat complications caused by liver damage.
Normally, blood from your esophagus, stomach, and intestines passes through your liver before going back to your heart. When the liver is damaged, scar tissue can form. This tissue is stiffer than healthy tissue, so it’s harder for blood to move through it. This can cause blood to back up in a major vein, leading to bleeding or a buildup of fluid in your abdomen if the pressure becomes too high. The TIPS procedure connects two main blood vessels in the liver to relieve this pressure and prevent complications.
Who Might Need a TIPS Procedure?
Your doctor may suggest a TIPS procedure if you have complications from liver disease that can’t be managed with medication or other treatments. These complications are usually related to increased pressure in the liver's blood vessels or severe liver damage, including:
- Portal hypertension: This condition causes high blood pressure in the portal vein, which carries blood from the digestive organs to the liver.
- Cirrhosis: Cirrhosis is scarring of the liver that happens after long-term damage from conditions like heavy alcohol use or hepatitis infections. This condition raises your chances of portal hypertension and its complications.
- Hemochromatosis: This is a genetic condition where your body absorbs too much iron. While iron is good for you in moderation, large amounts can be toxic and may damage the liver, causing scarring or high blood pressure in the portal vein.
- Ascites: Too much pressure in the portal vein, often caused by cirrhosis, can lead to fluid leaking from the vein into the abdomen, a condition known as ascites.
- Variceal bleeding: Pressure in the portal vein can cause other veins in the stomach, esophagus, or liver to rupture and bleed.
- Budd-Chiari syndrome: This condition blocks or narrows the veins that drain blood from the liver, often leading to complications like portal hypertension, ascites, and cirrhosis.
- Hepatorenal syndrome: A type of kidney failure caused by severe liver disease, often linked to portal hypertension.
- Refractory hepatic hydrothorax: Portal hypertension can also cause fluid buildup in the chest, called refractory hepatic hydrothorax.
Before a TIPS Procedure
Before the procedure, your doctor may order some tests to make sure you’re healthy enough for it. These could include a blood test, chest X-ray, a scan of your liver, or a heart test (an electrocardiogram or echocardiogram). Let your doctor know if you have any allergies, might be pregnant, or are taking any medications or supplements. If you’re on blood thinners, your doctor might ask you to stop taking them a few days before the procedure.
You shouldn’t eat or drink the night before the procedure, but you may be allowed to have clear fluids the day of.
How Is a TIPS Procedure Performed?
A TIPS procedure isn’t a surgery. Instead, a radiologist with special training to perform the procedure inserts a thin, hollow tube (called a catheter) into a vein in your neck, usually on the right side, and guides it into the liver using X-rays. At the end of the catheter is a small, inflatable balloon attached to a metal mesh tube called a stent. During the procedure, the balloon is filled with air to make space for the stent, which is put in place to create a new path for blood to flow more easily between the two main veins in your liver.
The procedure is usually done under general anesthesia, where you’re fully asleep. It can also be done using a local anesthetic, which numbs the area where the catheter goes, so you won’t feel pain. You’ll lie on your back while the area is shaved and cleaned before the catheter is inserted. The doctors will keep an eye on your heart rate and blood pressure throughout the procedure.
The procedure usually takes about an hour to an hour and a half, but it can last up to six hours. Once it’s done, the doctor will check the pressure in your main liver vein to make sure it has gone down.
After a TIPS Procedure
TIPS is an inpatient procedure, which means you’ll need to stay in the hospital for one or two days so doctors can make sure there are no complications, like bleeding. The catheter in your neck vein is usually taken out 24 hours after the procedure.
Since the incision is very small, you won’t need stitches. Usually, a bandage is placed over the site. You might feel some soreness or notice light bruising where the needle was inserted, but this should be minimal. Most people can return to their normal activities after about a week.
After the procedure, your doctor will perform an ultrasound to check that the stent is working correctly. You’ll need to have a follow-up ultrasound a few weeks later, and then every few months after that. If the procedure was done to manage ascites, you might be prescribed water tablets to help with fluid buildup.
Life Expectancy After a TIPS Procedure
How long someone lives after a TIPS procedure depends on several things, like the cause of their liver disease, their overall health, and how well their liver works afterwards. For people with severe liver disease, TIPS can improve their quality of life and lower the chances of developing life-threatening issues, like bleeding in the veins. It relieves portal hypertension in 80% to 90% of cases. For ascites, it is between 60% and 80% effective.
One study found that 88% of people who had TIPS for variceal bleeding were still alive two years later, and 61% survived for five years. When a TIPS procedure is done for portal hypertension, one study showed that survival rates are estimated to be about 79% after one year, 77.5% after two years, and 75% after five years. Another study found that on average, 60% of people who had TIPS for various reasons survived a year after the procedure. For those with Budd-Chiari syndrome, the outlook is much better, with most people regaining normal liver function. Survival rates for this group are estimated to be 90% at five years and 80% at 10 years after a TIPS procedure.
To improve long-term outcomes, make sure to schedule regular checkups and talk to your doctor to better understand your specific risks, as well as what to expect.
MELD score for TIPS
A MELD score, short for Model for End-Stage Liver Disease, is a number doctors use to measure how severe liver disease is. It helps predict how likely someone is to die from liver problems over the next three months and is also used to help prioritize patients for liver transplants. The scale starts at 6 and ends at 40, with higher scores meaning more serious liver disease.
The score is calculated by measuring your:
- Bilirubin: A substance that shows how well your liver is clearing waste.
- INR (International Normalized Ratio): Reflects how well the blood is clotting, which is affected by liver function.
- Creatinine: A measure of kidney function, which can be affected by liver disease.
A MELD score is also used to determine whether a TIPS procedure is a good option as well as predict how long a person might live afterward. For example, someone with a MELD score over 15 might face more complications after the procedure, and if the score is higher than 20, they might not be eligible for TIPS at all.
How long will TIPS work?
The results of a TIPS procedure can vary from person to person. For some people, the stent may narrow or become blocked over time, making it less effective. If this happens, you can have another procedure to reopen or replace the stent. With regular checkups and ultrasounds to make sure everything is working properly, the results of a TIPS procedure can last for years, improving quality of life and lowering complications related to liver disease.
Who Should Not Undergo a TIPS Procedure?
A TIPS procedure is usually not recommended for people with very advanced liver disease (those with a MELD score over 20) as it can increase the risk of liver failure. In these cases, a liver transplant is usually a better option.
It’s not suitable for people whose heart function on the right side isn’t strong enough to handle the increased blood flow, as the procedure can put extra strain on the heart. TIPS also isn’t recommended for those with liver cancer or if the portal vein is blocked by a blood clot.
You should not have this procedure if your blood has a low platelet count or if you have any kind of active infection.
TIPS Complications
A TIPS procedure is generally safe, but like any medical treatment, it carries a small chance of complications. The chances of complications are low — estimated around 3%-5%. These include:
- Damage to blood vessels
- Fever
- Shortness of breath
- Infection, bruising, or bleeding
- Allergic reactions
- Bruising or soreness around the incision
- Worsening kidney and liver function
Hepatic encephalopathy — a brain dysfunction that causes confusion, behavior changes, and may lead to coma — is the most common complication of the shunting effects of the procedure. This complication happens about 20% to 50% of the time.
Takeaways
A TIPS procedure is a nonsurgical treatment that helps blood flow more easily through the liver, relieving symptoms caused by liver disease. Many people have a better quality of life after the procedure, but long-term results depend on the severity of your liver disease and getting regular checkups. If you’re considering TIPS, talk to your doctor about whether it’s the right option for you and how to prepare for the procedure and recovery.
TIPS Procedure FAQs
How serious is a TIPS procedure?
A TIPS procedure is safer than surgery and usually isn’t painful. But it’s usually done to manage complications of liver disease, which is a serious health condition.
How long does a TIPS procedure take?
The procedure usually takes between one to two hours, but in some cases, it might take longer.
How successful is TIPS surgery?
TIPS improves symptoms in 80% to 95% of patients, but long-term results depend on the person. Most people experience a better quality of life after the procedure.
What is the most common complication after TIPS?
Hepatic encephalopathy, a brain dysfunction, is the most common complication after TIPS. This complication occurs 20% to 50% of the time, but it can usually be managed with medication.
How much does a TIPS procedure cost?
The cost of a TIPS procedure can vary based on the hospital, where you live, and your specific situation, but it typically ranges from $20,000 to $50,000. Check with your doctor and insurance company for a more accurate estimate.
