Radiological Procedure for Liver Failure

Transjuglar Intrahepatic Portosystemic Shunt (TIPS)-
A lifesaving radiological procedure in patients with cirrhosis

Our interventional radiologists routinely perform Transjuglar Intrahepatic Portosystemic Shunts (TIPS) as well as other interventional procedures required in patients with advanced liver disease, liver failure and portal hypertension.In patients with cirrhosis, there is increased pressure to flow of blood through the liver. This increased pressure is known as portal hypertension. Cirrhosis and portal hypertension leads to accumulation of excess fluid in the belly (ascites). Portal hypertension also leads to dilatation of blood vessels in the food-pipe and stomach (known as varices). These vessels can rupture and cause life threatening bleeding.Ascites is initially be managed medically with medications and restriction of salt and water intake. Gastrointestinal bleeding due to varices can be prevented as well as treated by endoscopic techniques known as Band Ligation. However, in some patients, such medical and endoscopic therapy is not effective. In such cases a procedure called Transjugular Intrahepatic Portal-systemic Shunt (TIPS) can be performed. This procedure leads to a decrease in the resistance to blood flow through the liver and thus helps in reducing the portal hypertension. This leads to control of ascites and gastrointestinal bleeding. Several years ago a similar procedure was done by open surgery but this had 10 to 60 percent risk of death. Since TIPS is done radiologically and does not involve any surgery, procedure-related mortality due to TIPS procedures is rare.The TIPS procedure involves creating a bypass inside the liver by placing a special expandable metal stent within the liver. X-ray guidance is used to find the correct vessels and to form a short pathway between them inside the liver. This relieves the high pressure in the veins and reverses the tendency for bleeding and fluid accumulation.The TIPS procedure can act as a bridge to liver transplantation in very sick patients. Some patients may be too ill to have the procedure however. In some patients, TIPS can cause mental confusion, worsening of liver failure and cardiac problems. Therefore, careful evaluation and consultation with specialists regarding treatment for liver failure is performed in every case.