Transjugular Intrahepatic Portosystemic Shunt
Reviewed and revised 20th October 2013
OVERVIEW
Transjugular Intrahepatic Portosystemic Shunt Procedure (TIPS) involves accessing the internal jugular vein and IVC to place a stent between the hepatic and portal veins using a needle
- this provides a conduit between the high pressure portal system and the lower pressure IVC system
- allows blood to bypass dilated oesophagus and gastric veins
- used in end stage liver failure
INDICATIONS
- variceal bleeding refractory to endoscopic banding or pharmacological measure
- ascites refractory to medical treatment
ANESTHETIC CONSIDERATIONS
- potential for massive haemorrhage and have a balloon tamponade in place -> resuscitate adequately
- haemodynamically stable induction
- invasive monitoring
- inotropes and blood products at the ready
COMPLICATIONS
- worsening of hepatic encephalopathy (high risk)
- pneumothorax
- arrhythmias
- massive bleeding
- infection
- failure of technique
- liver capsule perforation
- stent malposition, displacement or migration
- stent thrombosis or obstruction
References and Links
LITFL
- CCC – Gastrointestinal haemorrhage
- CCC – Upper Gastrointestinal Haemorrhage
- CCC – Lower Gastrointestinal Haemorrhage
- CCC – Transjugular Intrahepatic Portosystemic Shunt (TIPS) Procedure
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC