TIPS - Transjugular Intrahepatic Portosystemic Shunt
Brugsesteenweg
Rumbeke
Torhout
Menen
TIPS stands for Transjugular Intrahepatic Portosystemic Shunt. It is a tube that is placed to connect the blood vessel at the entrance of the liver to the blood vessel at the exit of the liver.
Aim of the research
A TIPS was recommended because the pressure at the portal vein at the entrance to the liver is currently too high. Increased pressure at the portal vein at the entrance to the liver usually occurs because the liver has become harder due to scar tissue. At an advanced stage, this is called liver cirrhosis.
A hard liver with increased pressure at the portal vein at the entrance to the liver causes complications such as fluid in the abdomen, bleeding at the level of varicose veins in the esophagus, etc. If these complications cannot be controlled with medication or other therapies, a TIPS may be placed.
Because a tube (TIPS) connects the portal vein at the entrance of the liver to the vein at the exit of the liver, the pressure decreases again at the level of the portal vein at the entrance to the liver. As a result, the complications of excessive pressure on the portal vein at the entrance to the liver would improve or even disappear.
After a TIPS, part of the blood will therefore no longer go through the liver for purification.
Preparation
- Before a TIPS can take place, you need to look at your heart function. Before that, an ultrasound of the heart will be performed. This is necessary because more blood will flow to the heart again after a TIPS has been placed. We need to make sure that your heart is still in good condition so that your heart can also process this blood.
- A scan of your liver is often also required to identify, among other things, new blood vessels in the abdomen that have occurred because your portal vein at the entrance to your liver has been under high pressure for a long time.
- Sometimes it is necessary to estimate the extent to which confusion can occur after placing a TIPS (see complications). To do so, you will be referred to a neurologist.
- You must give your explicit consent to the procedure and to receive anaesthesia in the “patient book” that you receive from your doctor
- This procedure requires that you remain sober. This means that you are not allowed to eat, drink or smoke 4 hours before you post a TIPS.
Home medication
Be sure to bring your home medication to the consultation beforehand. Certain medications must be stopped before a TIPS can be placed. For example, blood thinning such as aspirin, asaflow, clopidogrel, etc. should be stopped 5 to 7 days before surgery.
Execution
The placement of a TIPS is done under general anesthesia and is performed by the interventional radiologist in the radiology department.
During the procedure, an access route is made via a vein in the neck. A tube is moved along this jugular vein towards the liver. This way, the portal vein is punctured across the liver tissue. In order to simplify the puncture of the portal vein, in addition to the access route in the neck, a small access route is often also made into an artery in the groin. Once the portal vein has been punctured via the neck, the route through the liver is widened with a balloon that is also introduced via the neck. Finally, the route made through the liver is perpetuated by placing a stent. The total duration of the procedure can vary considerably, but it usually takes about 2 hours. After the procedure, you will wake up again in the hospital's awakening department.
Hospitalization
After the examination
After placing a TIPS, you must stay in the intensive care unit for one night for observation. The day after the procedure, an ultrasound of the liver should be done to check. After your stay in intensive care, you can return to the regular residence department. There, you will be seen by the on-call gastroenterologist; you will be checked on the neck; your blood pressure, heart rate and temperature will be measured; your consciousness will be checked, etc.
If everything goes well, you can leave the hospital again after a few days.
A check-up appointment will be given for a consultation with your liver doctor after a few weeks to see if everything is going well.
Important
When you return home:
- in case of bleeding from the puncture site in the neck;
- in case of bleeding from the puncture site in the groin;
- when confusion occurs;
Consult your doctor right away.
Advantages and disadvantages
Side effects
Points of interest
If you choose not to place TIPS with you (patient choice or medical reasons), we may try to permanently suppress the complications associated with liver cirrhosis (e.g. medication, abdominal fluid punctures, etc.).
If you are in good general condition, you can opt for a liver transplant. To do this, we forward the patients to UZ Leuven or UZ Gent.
Risks of this study
During the procedure
There are some risks associated with posting a TIPS.
- Accidental puncture of the lungs.
- When the catheter passes through the heart, it may be that a heart rhythm disorder is currently caused.
- Bleeding.
After surgery
In the recovery period, we must be attentive to the following complications:
- Delay and/or confusion. Because the blood is no longer filtered by the liver after a TIPS, certain harmful substances end up directly into the bloodstream. This can lead to disorders of consciousness, which can cause confusion, delayed speech, etc.
- The TIPS tube may narrow or close.
- Heart failure can occur after placing a TIPS. This is because more blood passes through the heart again.
- Sometimes a TIPS doesn't work enough or works too much. Then you can choose Infomap liver cirrhosis - Transucular Intrahepatic Portosystemic Shunt (TIPS) procedure to adjust the TIPS. This means that the TIPS tube can be dilated or narrowed again.
