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TIPS (Transjugular Intrahepatic Portosystemic Shunt)

Catheter-based portal decompression for advanced cirrhotic complications

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Radyoloji department. Book Appointment →

What is TIPS (Transjugular Intrahepatic Portosystemic Shunt)?

Transjugular intrahepatic portosystemic shunt (TIPS) is a percutaneous procedure that creates an artificial channel through liver parenchyma between a hepatic vein branch and an intrahepatic portal vein branch, then maintains the tract with a covered stent-graft. By bypassing the cirrhotic liver, TIPS reduces portal venous pressure (portosystemic gradient < 12 mmHg target), thereby decompressing collaterals and reducing variceal bleeding and ascites formation.

Indications include refractory variceal hemorrhage failing endoscopic and pharmacologic therapy, refractory ascites, hepatic hydrothorax, Budd-Chiari syndrome, hepatorenal syndrome and portal vein thrombosis. Modern PTFE-covered stents (Viatorr) have dramatically reduced shunt occlusion rates. Pre-emptive early TIPS within 72 hours improves survival in high-risk Child-Pugh B-C variceal bleeders.

Symptoms

Recurrent variceal hemorrhage despite optimal therapy
Refractory ascites requiring frequent paracentesis
Hepatic hydrothorax
Budd-Chiari syndrome with hepatic vein thrombosis
Hepatorenal syndrome
Portal vein thrombosis with cavernous transformation
Severe gastropathy from portal hypertension
Pre-liver-transplant decompression

Risk Factors

Decompensated cirrhosis with high MELD
Right heart failure (contraindication)
Severe pulmonary hypertension (contraindication)
Polycystic liver disease
Severe hepatic encephalopathy
Active sepsis
Hepatocellular carcinoma in shunt path
Severe coagulopathy

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Recurrent gastrointestinal bleeding from varices
  • Refractory ascites needing repeated paracentesis
  • Hepatic hydrothorax with dyspnea
  • Severe portal hypertension on imaging
  • Worsening hepatorenal syndrome
  • Symptoms of new or worsening encephalopathy after TIPS
  • Bridge to liver transplant evaluation

Treatment Methods

01
Pre-procedural cardiac echocardiography to exclude right heart strain
02
Multidisciplinary review of MELD, Child-Pugh and indication
03
Right internal jugular vein access under ultrasound
04
Hepatic vein cannulation and portal vein puncture under fluoroscopy
05
Tract dilation and PTFE-covered stent (Viatorr) deployment
06
Final portosystemic gradient measurement (target < 12 mmHg)
07
Post-procedural Doppler ultrasound at 24 hours and 1 month
08
Lactulose, rifaximin and sodium restriction for encephalopathy prevention
09
Lifelong shunt patency surveillance with Doppler ultrasound

Which Department to Visit?

You can visit our Radyoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.