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