After a TIPS placement, a small number of patients can experience problems with their TIPS, either related to too much flow, or too little flow, through the TIPS shunt. At Vascular and Interventional Partners in Scottsdale, AZ, our interventional radiologists are trained in and have years of experience performing TIPS revisions using minimally invasive techniques.
What Is a TIPS Revision?
A TIPS revision is a minimally invasive procedure to correct complications after a TIPS procedure. TIPS is short for transjugular intrahepatic portosystemic shunt (TIPS), which is an artificial channel that we create to connect the portal vein to a hepatic vein in the liver. A TIPS procedure is performed to treat portal hypertension, a common complication of liver cirrhosis.
Although a TIPS procedure is quite effective with high success rates, some patients who undergo this procedure develop complications and require a TIPS revision. In most cases, a TIPS revision involves one of the following procedures:
- Balloon angioplasty — To perform an angioplasty, your provider introduces a catheter through a neck vein and advances a special balloon catheter into the shunt. The balloon is inflated to open up the shunt and increase blood flow.
- Additional stent placement — In many cases, your provider may also need to place a new stent to optimize flow in your TIPS. This procedure is performed by placing the stent in the appropriate location and inflating a balloon to open it.
- Thrombectomy — If a clot has formed in the TIPS shunt, your doctor can use special catheters, balloons and medication to remove the clot and restore flow in the TIPS.
- TIPS reduction — If there is too much flow in the TIPS, this can sometimes cause a complication called hepatic encephalopathy. In rare cases, your doctor will use special stents or equipment to narrow the TIPS shunt, thereby slowing down the flow. In extreme cases, a TIPS can even be shut down completely.
Although these are the most common procedures, a TIPS revision can also involve many other minimally invasive methods.
Why You May Need a TIPS Revision
The most common reason for a TIPS revision is a blockage or clot forming within the shunt, or poor flow near the top part of the shunt in the hepatic vein. In these instances, either thrombectomy, balloon angioplasty or stent placement can fix the problem.
Your doctor may suggest a TIPS revision if sonography findings show shut dysfunction or if you have recurrent symptoms of portal hypertension, like gastrointestinal bleeding, abdominal fluid buildup or confusion (hepatic encephalopathy).
Fortunately, as TIPS stents have improved over the last several decades, complications related to the TIPS stent are now rarer. However, problems can still arise and should be addressed promptly by a doctor experienced in TIPS procedures.
Why Choose Vascular and Interventional Partners?
A TIPS revision can correct occlusions and other problems with your TIPS. Our interventional radiologists have been specially trained to perform a number of TIPS revisions on a wide range of patients with portal hypertension.
At our practice in Scottsdale, AZ, we make sure to be at the forefront of the latest innovations in interventional radiology and to offer our patients the best care possible. To learn more about interventional radiology procedures for TIPS complications and how you can get treated at our facility, contact or call us today at 480-435-9100.
Frequently Asked Questions
Why does a TIPS become blocked?
There are many reasons why a TIPS may become blocked, including formation of a clot in the shunt or narrowing of the vessel adjacent to the shunt. Newer types of TIPS stents with polytetrafluoroethylene (PTFE) covering have reduced the risk of complications significantly, with over 70 percent of TIPS functioning well after two years.
How do I know if there’s a problem with my TIPS?
Your doctor may recommend getting regular TIPS evaluations using ultrasound or other imaging techniques. This can help evaluate the blood flow in your TIPS to rule out stenosis or other problems. If you develop symptoms of portal hypertension, that is also a sign of an issue with your TIPS. Most commonly, this presents as either reaccumulation of fluid in the belly or chest or as new GI bleeding.
What happens during a TIPS revision?
You may need to be sedated or put under general anesthesia for this procedure. A typical TIPS revision goes as follows: your provider will create an access point in your neck. Using ultrasound guidance, they will guide a catheter down major veins to the shunt site and inflate a balloon at the end of the catheter. If necessary, they may also place a stent to keep the shunt open. In some cases, providers need to directly access the portal vein with a cannula inserted into the abdomen.
How long does a TIPS revision take?
A TIPS revision can take two to three hours, depending on the complexity of the procedure and whether your provider has trouble accessing the shunt. Since this procedure is often performed on an outpatient basis, patients can go home on the day of their procedure.
How successful is a TIPS revision?
TIPS revision has a near 100 percent technical success rate. However, if you are getting a parallel TIPS, this can also result in further occlusions that require further revisions.
What happens when a TIPS revision fails?
When a TIPS revision is not successful, and there is no possibility of creating a parallel TIPS, we may create a transcaval TIPS, which uses a different access point for shunt placement.
Can a TIPS be removed?
In short, no. Once a TIPS has been implanted, scar tissue forms around it that makes removal difficult and risky. However, the TIPS can be intentionally shut down or “occluded” to reverse its effects.