Trans-jugular intrahepatic portosystemic shunt (TIPSS)
What is a TIPSS procedure?
- T is for trans-jugular (through the neck)
- I is for intrahepatic (into the liver)
- PS is for portosystemic (portal to hepatic vein)
- S is for shunt (metal stent/tube)
Sometimes with liver disease, blood flow through the liver is restricted causing an increase in the blood pressure in the liver. This is called portal hypertension. This back pressure of blood can cause a network of enlarged and weak veins to develop in the oesophagus and the stomach, 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.
Portal hypertension can also result in a build-up of fluid in the abdomen, called ascites.
A TIPSS procedure is one way to treat portal hypertension. It involves inserting a metal tube (shunt) 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 shunt remains in place permanently. A large vein in your neck (jugular vein) is used to reach your liver.
Risks and benefits
The benefit of this procedure is that it will help us treat your symptoms while avoiding the risks of surgery. It will lower your blood pressure to your liver. If you are experiencing blood loss or a build-up of fluid in your abdomen, it should also reduce this.
It is common to get a small bruise on your neck at the needle entry site. Rarely the bruise may be large with a small risk of getting infected which may need treating with antibiotics. Very rarely, some damage can be caused to the vein which may need treating by surgery. There is also a very small risk that bleeding might occur from the liver where the shunt has been placed.
After this procedure you might develop a build-up of toxins in your blood which might cause you to experience some confusion. There is a small possibility that the procedure may be unsuccessful. Over time the shunt may become narrowed or even block off and the procedure may need to be repeated. For this reason, regular follow-up is important. We will discuss all the risks and benefits with you in detail before your procedure.
Before you come in
Please let your doctor know if you take warfarin (tablet to thin the blood) or have any allergies. You will also require a blood test before the procedure.
What happens on the day of my appointment?
You need to fast for six hours before your procedure. Please take all your medications as usual (except aspirin, warfarin or metformin). You will be admitted to hospital. On the ward your nurse and doctor will ask you several questions about your health and current medication and they will check your blood pressure and pulse. They will and ask you to change into a gown.
Before the procedure
Your nurse will bring you to the X-ray Department on your bed. In the X-ray Department you will be seen by a doctor. This is an opportunity to discuss the procedure before you sign a consent form. Please ask any questions you may have as it is important that you understand what is going to happen. Sometimes this procedure is done under general anaesthetic. In this case the anaesthetist will come and discuss this with you.
During the procedure
In the procedure room you will lie on an X-ray table. Your neck will be cleaned with antiseptic fluid and you will be covered with a sterile drape. The doctor will give you an injection of local anaesthetic to numb the skin in your neck just by your collarbone. This will cause some stinging initially and then go numb. If you are not having a general anaesthetic, you will be given some sedation through a needle in your arm which will make you feel drowsy and relaxed.
Throughout the procedure a nurse will monitor your pulse and blood pressure and give you some oxygen. Please let the nurse know if you feel any discomfort.
The doctor will insert a catheter (fine plastic tube) into the vein in your neck. Once the catheter is in the right position, the doctor will try to make a track from your portal vein to your hepatic vein. A thin metal tube, called a stent, will then be placed across this track to hold it open. The procedure usually takes about two hours but may take longer.
After the procedure
If you have had a general anaesthetic, you will be woken up by the anaesthetist. Once you have woken up fully, you will go back to the ward where your nurse will record your pulse and blood pressure as well as check the needle site regularly. You will also have an oxygen mask on for a couple of hours. You will be required to rest in bed for four hours. If you feel unwell or are in any discomfort at any time please tell your nurse. They will be able to give you some pain-relieving medication. After four hours, you will be able to eat and drink.
If the procedure was not successful, your doctor will discuss with you the possibility of going to theatre for surgery.
Contact information
Chelsea and Westminster Hospital
Interventional Radiology Department
1st Floor, Lift Bank D
T: 020 3315 8570/8582