Transjugular Intrahepatic Portosystemic Shunt (TIPSS)
Date issued: October2024
For review: October 2026
Ref: B-298/RA/Imaging/Transjugular Intrahepatic Portosystemic Shunt TIPSS v2
PDF: Transjugular Intrahepatic Portosystemic Shunt TIPSS.pdf [pdf] 218KB
This leaflet tells you about having a transjugular intrahepatic portosystemic shunt (TIPSS) insertion. It explains what is involved and what the possible risks are. It is not meant to replace informed discussion between you and your doctor but can act as a starting point for such discussions. If you have any questions about the procedure, please ask the doctor who has referred you or the department which is going to perform it.
Referral and consent
The referring clinician should have discussed the reasons for this examination with you in the clinic and you should make sure that you understand these before attending. You will be referred to an Interventional Radiologist for this procedure.
Interventional Radiologists are doctors who have trained and specialised in imaging and x-ray treatments.
Before the procedure you will need to sign a consent form, if one hasn’t previously been completed. This form says that you need to know what risks are involved. This is a legal requirement and ensures that you are fully informed about your procedure.
If after discussion with your hospital doctor or Radiologist, you do not want this examination then you can decide against it. If the Radiologist feels that your condition has changed or that your symptoms do not indicate such a procedure is necessary, then they will explain this to you and communicate with the referring clinician. You will return to your referring clinician for review.
At all times the radiologist and referring clinician will be acting in your best interests.
What is a Transjugular Intrahepatic Portosystemic Shunt?
A Transjugular Intrahepatic Portosystemic Shunt (TIPSS) is a procedure that creates an internal ‘bypass’ between the vein supplying the liver (portal vein) and the veins draining the liver (hepatic veins).
What is a stent?
A stent is a special device made of metal mesh that is placed across a narrowing or blockage to keep the vessel open.
Why do you need a TIPSS?
Patients with liver disease can have complications, such as bleeding from distended veins in the gullet (varices) and fluid collection (ascites), due to an increase in the blood pressure in the portal vein. The TIPSS procedure treats these complications by reducing the blood pressure in the portal vein.
The doctors looking after you will have been treating your varices or ascites by other means. They have decided these other methods of treatment are no longer effective and the best treatment for you now is a TIPSS.
Are there any risks?
TIPSS is generally a safe procedure, but as with any medical procedure there are some risks and complications that can arise. The risks of having a TIPSS are low (1–2%).
The main risk is bleeding. This may require a blood transfusion or, very rarely, an additional X-ray guided procedure to identify and treat the bleeding site.
After the procedure, you may experience some shortness of breath. This can be treated with a short course of water tablets. If the TIPSS has been placed to treat ascites, you may find that you pass increased amounts of urine for the first 24–48 hours. This is a good sign suggesting that the TIPSS has worked. You may, however, require a drip if you are unable to drink enough to replace the excess urine you are producing.
Occasionally, the bypass effect of the TIPSS can potentially cause deterioration in your liver function. This is often transient. You may become a little confused. This is often treated successfully by altering your diet and medication. Very occasionally, these measures may not work, and you may require a further procedure to reduce the amount of blood flowing through the TIPSS or to block the TIPSS to resolve the liver function or confusion.
The stent can become narrowed or blocked, and this may require a further procedure where a special balloon to dilate the stent.
Sepsis can occur which is treated with a course of antibiotics.
Very occasionally there may be injury to your bile ducts which may lead to surgery.
Some complications can be life threatening and although rare, death should also be considered as a risk of this procedure.
If you are pregnant or suspect that you may be pregnant you should notify the department. A baby in the womb may be more sensitive to radiation than an adult. There is no problem with something like an x-ray of the hand or chest because the radiation field is at a safe distance from the foetus. However, special precautions are required for examinations where the womb is in, or near, the beam of radiation. If you are a female of childbearing age the radiographer will ask you if there is any chance of you being pregnant before the examination begins and you will be asked to sign a form. If there is a possibility of pregnancy, then your case will be discussed with the team looking after you to decide whether or not to recommend postponing the investigation.
There will be occasions when diagnosing and treating your illness is essential for your health and where the benefit clearly outweighs the small radiation risks. The procedure may go ahead after discussing all the options with you.
Are you required to make any special preparations?
You need to be an inpatient for the procedure. You will be asked not to eat or drink for six hours before the procedure.
If you have any allergies or have previously had a reaction to the dye (contrast agent), you must tell the radiology staff before you have the test.
If your blood clotting is abnormal, you may be given special blood transfusions to try and correct this. If you have any concerns about having blood transfusions, you should discuss these with your doctor.
Who will you see?
A specially trained team led by an Interventional Radiologist within the radiology department. Interventional Radiologists have special expertise in reading the images and using imaging to guide catheters and wires to aid diagnosis and treatment.
Where will the procedure take place?
In the interventional radiology suite, which is located within the radiology department. This is similar to an operating theatre into which specialised X-ray equipment has been installed.
What happens during a TIPSS?
The Interventional Radiologist will explain the procedure and ask if you have signed a consent form. Please feel free to ask any questions that you may have and, remember that even at this stage, you can decide against going ahead with the procedure if you so wish.
A TIPSS is commonly performed under a general anaesthetic, although in some hospitals it may be performed with local anaesthetic and sedation. You should discuss the type of an anaesthetic you will be having with your doctors.
Once you are asleep, or the skin in the neck has been numbed, a small tube (catheter) is inserted into the vein at the side of the neck. X-ray equipment is used to guide the catheter into the hepatic vein in the liver. A needle is then used to create a track between the hepatic vein and portal vein, through the liver. Once the track has been made, it is kept open by placing a metal tube, called a stent, to hold the track open.
Will it hurt?
At the end of the procedure, once you are awake, you may be sore at the side of your neck, but this will resolve over a few days.
How long will it take?
Every patient is different, and it is not always easy to predict; however, expect to be in the radiology department for about two to three hours.
What happens afterwards?
You will be taken back to your ward on a trolley. Nurses on the ward will carry out routine observations, such as taking your pulse and blood pressure, to make sure that there are no problems. You will normally be discharged after 24–48 hours.
Other Risks
TIPSS is a safe procedure but as with any procedure or operation complications are possible. We have included the most common risks and complications in this leaflet.
We are all exposed to natural background radiation every day of our lives. This comes from the sun, food we eat, and the ground. Each examination gives a dose on top of this natural background radiation.
Any exposure to ionising radiation (e.g. X-rays) has the potential to cause cancer later in life. This is much lower than the risk we all have of developing cancer in our life of ~1 in 3 and will be considered by the doctor before your procedure.
For information about the effects of X-rays read the publication: “X-rays how safe are they” on the Health Protection Agency
Finally
Some of your questions should have been answered by this leaflet but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure.
Contact
Interventional Radiology Department
01752 432063 – Bookings Clerk
01752 430838 – IR Co-ordinator
Additional Information
Bus services:
There are regular bus services to Derriford Hospital. Please contact:
Car parking:
Hospital car parking is available to all patients and visitors. Spaces are limited so please allow plenty of time to locate a car parking space. A charge is payable.
Park and Ride:
Buses (1/1A/42C/34) run from the George Junction Park and Ride Mon-Sat (except Bank Holidays) every 15/20 mins from 6am. The last bus leaves the hospital at 11:30pm.
Plympton Park and Ride (52) runs from Coypool Park and Ride.
Parking is free although you will need to purchase a ticket to travel on the bus.
Patient Transport:
For patients unable to use private or public transport please contact The Patient Transport Service:
Devon GP: 0345 155 1009
Cornwall GP: 01872 252211
Comments and Suggestions
We welcome comments and suggestions to help us improve our service.
