Cirrhosis of the liver kills 25,000 people in the United States each year and is the 11th leading cause of death, the American Gastroenterological Association reported in 2007. A liver transplant, which entails the removal of the diseased liver and replacement with a donor cadaver liver or part of a living donor's liver, is the only cure for cirrhosis. A liver transplant can entail long wait times because the supply of donated organs doesn't meet the demand. Placement of a transjugular intrahepatic portosystemic shunt, commonly known as a TIPS procedure, reduces potentially life-threatening cirrhosis complications.
Definition
The TIPS procedure places an artificial shunt between the portal vein, which carries blood into the liver, and the hepatic vein, which carries blood from the liver back to the heart.
Purpose
The TIPS shunt reduces the amount of blood that passes through the damaged liver. Because part of the liver no longer functions when cirrhosis is present, blood entering the liver backs up and distends blood vessels in the esophagus and stomach. The distended blood vessels often bleed and can cause life-threatening blood loss if they burst.
The backup of fluid also causes ascites, which occurs when fluid builds up in the lungs, abdomen and sometimes the lungs. Ascites fluid causes shortness of breath and crowding of nearby organs and can become infected. Paracentesis, removal of ascites fluid through a needle, effectively reduces fluid but it often reaccumulates, and frequent paracentesis increases the risk of infection. The TIPS procedure reduces both of these serious complications of cirrhosis.
Procedure
A TIPS is a surgical procedure done through the jugular vein in the neck. Under X-ray visualization, a tube is threaded through the jugular vein, usually by a radiologist. The patient might receive mild sedation or general anesthesia during the procedure. The catheter is placed in the portal vein and kept in place by an inflated balloon, attached to a metal mesh stent, the University of Maryland Medical Center explains. The other end of the stent is placed in the hepatic vein, allowing some blood to bypass the liver and decrease pressure in the blood vessels leading to it.
Complications
TIPS can increase the chance of encephalopathy, which is a buildup of toxins in the brain. Toxins normally removed from the blood by the liver bypass the liver, accumulating in the bloodstream. Symptoms of encephalopathy include confusion, irritability, personality changes and, eventually, coma and death, according to the Merck Manual. TIPS also accelerates liver failure in some cases, MayoClinic.com warns.
Complications of the TIPS procedure itself include fever, infection, bleeding, damage to the blood vessels or heart problems, according to the University of Maryland Medical Center.
Considerations
TIPS might help reduce esophageal varices and ascites while a person waits for liver transplant. However, TIPS creates serious complications of its own. TIPS is best used when all other treatment to control varices or ascites have failed, according to MayoClinic.com.
