A transjugular intrahepatic portosystemic shunt (or TIPS) procedure is usually used to treat patients with portal hypertension complications like variceal bleeding, portal gastropathy, severe ascites and Budd-Chiari syndrome.
The interventional radiology team performs TIPS procedures. Because we do not want your child to be in any discomfort or to move, this procedure is performed under general anesthesia. An anesthesiologist will come speak to you prior to the exam, as will the radiologist performing the procedure. They will explain what will occur and answer any questions that you may have.
This procedure uses ultrasound and fluoroscopic imaging (live images) to create a pathway within the liver connecting the portal vein to the hepatic vein. The radiologist will use ultrasound to access the internal jugular vein. This area will be numbed with lidocaine prior to making the small incision in the neck area. They will then insert catheters and measure the pressure within the hepatic vein for a baseline pressure measurement. They will also inject a contrast media to help them visualize the portal venous system.
Once they can clearly identify the anatomy, the radiologist will cross the hepatic vein into the portal system. It is here that they will make the pathway between the portal vein and the hepatic vein. The radiologist will then place a stent through this pathway to keep the connection patent (open). The radiologist will repeat the pressure measurements again to document improved pressure gradients.
Your child will have a small dressing placed over the incision to keep it clean before waking up from the anesthesia.