What to Expect During a TIPS Procedure
Image-guided, minimally invasive procedures such as a TIPS are most often performed by a specially trained interventional radiologist. Some interventional radiologists prefer performing this procedure while the patient is under general anesthesia, while some prefer conscious sedation for their patient.
You will be positioned on your back.
You will be connected to monitors that track your heart rate, blood pressure and pulse during the procedure.
A nurse or technologist will insert an I.V. into a vein in your hand or arm so that sedative medication can be given intravenously. You also may receive general anesthesia.
The area of your body where the catheter is to be inserted will be shaved, sterilized and covered with a surgical drape.
Your doctor will numb the area near your right collarbone with a local anesthetic.
A very small nick is made in the skin at the site.
Using ultrasound, the doctor will identify your internal jugular vein, which is situated above your collarbone, and guide a catheter, a long, thin, hollow plastic tube into the vessel.
Using a fluoroscope, the doctor will then guide the catheter 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. To help plan for the placement of the TIPS stent, a contrast material will be injected in the hepatic vein to outline the portal venous system. 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.
The balloon is then deflated and removed along with the catheter.
Pressures are measured to confirm reduction in portal hypertension. Additional portal venograms also are performed to confirm satisfactory blood flow through the TIPS.
Pressure will be applied to stop any bleeding and the opening in the skin is covered with a bandage. No sutures are needed.
You will be admitted to the hospital following your procedure, where you will be closely observed.
This procedure is usually completed in an hour but may take up to several hours depending on the complexity of the condition and vascular anatomy.
Devices to monitor your heart rate and blood pressure will be attached to your body.
You will feel a slight prick when the needle is inserted into your vein for the I.V. and when the local anesthetic is injected.
If you receive a general anesthetic, you will be unconscious for the entire procedure, and you will be monitored by an anesthesiologist.
The I.V. sedative will make you feel relaxed and sleepy. You may or may not remain awake, depending on how deeply you are sedated.
When the needle is advanced through the liver and the pathway is expanded by the balloon, you may experience discomfort. If you feel pain, you should inform your doctor; you may be given extra intravenous medications.
As the contrast material passes through your body, you may get a warm feeling.
After the procedure, you will be monitored closely and your head will be kept elevated for a few hours after you return to your room. Often, symptoms are mild or controlled enough that you may go home the next day. However, the amount of bleeding that can occur can sometimes be life threatening and those patients are monitored in intensive care beforehand and during recovery.
You should be able to resume your normal activities in seven to 10 days.
Follow-up ultrasounds will be performed frequently after the TIPS procedure to make sure that it remains open and functions properly.
Limitations of TIPS
Patients with more advanced liver disease are at greater risk for worsening liver failure after TIPS. They also are at risk for encephalopathy, an alteration of normal brain function that can lead to confusion. This is because toxic substances in the bloodstream are ordinarily filtered out by the liver. 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, but sometimes the stent must be blocked off intentionally to solve the problem.