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Usually the TIPS procedure is performed in children under general anesthesia. Once the patient is asleep, the neck is washed with an iodine solution to sterilize it and the patient is covered with sterile drapes to prevent infection. The interventional radiologist passes a needle through the skin of the neck and into the right internal jugular vein. This needle is then replaced with a catheter system that extends from the jugular vein to the hepatic veins (main veins in the liver).
The catheter system is used to pass a long needle through the liver tissue between the hepatic vein and the portal vein. Once the needle has entered the portal vein, a guide wire is placed into the main portal vein, the needle is removed, and the guide wire is used to then pass a balloon catheter into the main portal vein. The balloon is inflated and this enlarges the track between the two veins.
The balloon catheter is then removed and a catheter which has been loaded with a metal stent (tube of metallic mesh) is placed across the track between the two veins. The stent is enlarged by the balloon catheter until it widens the track to the appropriate size. The radiologist determines the appropriate size by measuring the pressures across the track or shunt and by viewing the portal vein with angiographic images. Once the pressures and angiographic picture are desirable, the catheters are removed and general pressure is applied to the site of catheter entry in the neck until there is no further bleeding. The patient is then transferred to the Recovery Room for observation.
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Transjugular Intrahepatic Portosystemic Shunt (TIPS)
