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
Leave a Reply