Transjugular Intrahepatic Portosystemic Shunt Therapy

Intrahepatic Jugular Vein Stenting Therapy

My father recently visited the doctor due to issues related to liver cirrhosis (currently in the second to third stage of cirrhosis).
The physician recommended the use of transjugular intrahepatic portosystemic shunt (TIPS) therapy.
I would like to inquire about the potential benefits and possible side effects of this treatment from your professional medical team.

cc, 30~39 year old female. Ask Date: 2002/07/26

Dr. Xu Ruihong reply Gastroenterology and Hepatology

Hello, the intrahepatic stenting therapy for the jugular vein involves the direct placement of a stent between the portal vein and hepatic vein to achieve a reduction in portal pressure.
Once the portal pressure is lowered, the likelihood of esophageal variceal or gastric variceal bleeding decreases, and there is also significant improvement in the patient's ascites.
Theoretically, this procedure can enhance the patient's quality of life; however, a significant portion of patients may experience hepatic encephalopathy post-surgery, leading to prolonged bed rest or frequent bathroom visits due to lactulose intake, which can negatively impact their quality of life.
Of course, there are also patients who do very well after the procedure.
The potential complications of this surgery include: 1.
Bleeding: Patients with cirrhosis often have poor coagulation function, which may result in significant intrahepatic or extrahepatic bleeding during the procedure.
2.
Hepatic encephalopathy (as mentioned earlier).
3.
Stent occlusion: This can lead to a re-elevation of portal pressure and the recurrence of complications associated with cirrhosis.
Another stent can be placed at this time if necessary.
4.
Infection: After connecting the portal vein and hepatic vein, there is an increased risk of infection.
5.
High cost.

Reply Date: 2002/07/26

More Info

Transjugular Intrahepatic Portosystemic Shunt (TIPS) therapy is a minimally invasive procedure designed to alleviate complications associated with portal hypertension, which is often a result of liver cirrhosis. In your father's case, where he is experiencing complications from cirrhosis, TIPS may be a recommended treatment option.

What is TIPS?
TIPS involves creating a channel within the liver that connects the portal vein (which carries blood from the digestive organs to the liver) to the hepatic vein (which carries blood away from the liver). This shunt helps to reduce the pressure in the portal vein, thereby alleviating symptoms associated with portal hypertension, such as variceal bleeding and ascites (fluid accumulation in the abdomen).

Indications for TIPS
TIPS is typically indicated for patients with:
- Recurrent variceal bleeding that cannot be controlled with endoscopic therapy or medication.

- Severe ascites that is refractory to diuretics and paracentesis (fluid removal).

- Hepatic hydrothorax (fluid accumulation in the pleural cavity due to liver disease).

- Other complications of portal hypertension.

Potential Benefits
1. Reduction in Portal Pressure: By creating a shunt, TIPS can significantly lower portal vein pressure, which can help prevent variceal bleeding and improve symptoms of ascites.

2. Improvement in Quality of Life: Many patients experience relief from symptoms such as abdominal swelling and discomfort, leading to an improved quality of life.

3. Minimally Invasive: Compared to traditional surgical options, TIPS is less invasive and can often be performed under local anesthesia with sedation.

Possible Risks and Complications
While TIPS can be beneficial, it is not without risks. Some potential complications include:
1. Hepatic Encephalopathy: This is a condition where toxins build up in the bloodstream due to liver dysfunction, leading to confusion, altered consciousness, and in severe cases, coma. Patients may require medications such as lactulose to manage this condition post-procedure.

2. Bleeding: There is a risk of bleeding during the procedure, especially in patients with compromised liver function.

3. Infection: As with any invasive procedure, there is a risk of infection at the site of the shunt or within the abdominal cavity.

4. Shunt Dysfunction: Over time, the shunt can become blocked or narrowed, necessitating further intervention.

5. Liver Failure: In some cases, the procedure can exacerbate liver dysfunction, particularly in patients with advanced liver disease.

Post-Procedure Management
After TIPS, patients are typically monitored closely for signs of complications. Management may include:
- Regular follow-up imaging to assess the patency of the shunt.

- Monitoring for signs of hepatic encephalopathy and adjusting medications as necessary.

- Nutritional support and counseling, as dietary changes may be needed.

Conclusion
In summary, TIPS can be an effective treatment for managing complications of portal hypertension in patients with liver cirrhosis. However, it is essential to weigh the potential benefits against the risks, particularly in patients with advanced liver disease. It is crucial to have a thorough discussion with your father's healthcare team to understand the specific indications for TIPS in his case, the expected outcomes, and the management of potential complications. This collaborative approach will help ensure that your father receives the most appropriate care tailored to his individual needs.

Similar Q&A

Managing Ascites in Cirrhosis: Finding Relief for Your Loved One

My father has cirrhosis and has to go to the hospital every week to have ascitic fluid drained, with at least 3000 to 4000 cc being removed each time. However, no matter how much fluid is drained, his abdomen remains distended and unchanged in size. He mentioned that the doctor o...

Dr. Chen Shidian reply Gastroenterology and Hepatology
Hello Miss Yueyue, in the case of end-stage liver cirrhosis (with poor response to diuretics), liver transplantation should be considered for long-term stability. Additionally, a medical center can place a stent in the hepatic blood vessels to reduce hepatic blood flow pressure, ...

Understanding Liver Cysts: Treatment Options and Safety for Seniors

Dear Dr. Liang, My father is 75 years old and has three cysts in his liver measuring 1.5 cm, 2 cm, and 3 cm. After a liver biopsy, there are concerns about potential lesions. The doctor has suggested either transarterial embolization or alcohol injection. I am worried about whet...

Dr. Liang Jiade reply Gastroenterology and Hepatology
Multiple tumors have been found in the liver. If a liver biopsy confirms hepatocellular carcinoma or other malignant tumors, further imaging studies are necessary to determine the size, number, and location of the tumors, which will help decide the appropriate treatment approach....

Managing Bile Leakage After Liver Resection: Treatment Options and Recovery

Hello, I underwent a liver resection surgery on January 27, during which the tumor located at the bile duct bifurcation was removed along with the bile and bile ducts, and a segment of the small intestine was used as a bile duct. Since the resection, I have been suffering from bi...

Dr. Chen Shidian reply Gastroenterology and Hepatology
Hello, sir: The situation is complex and requires assessment based on the actual condition. We will consult a senior gastroenterologist for advice. Changhua Hospital cares about your health. Chen Shidian

Are There Effective Treatments for Liver Cirrhosis in Taiwan?

Hello, Director. I am a bride from Mainland China. My sister-in-law has had hepatitis B since she was young. Due to the lack of obvious symptoms, she did not pay much attention to managing this condition. Now at 40 years old, with four children, my sister-in-law has progressed fr...

Dr. Chen Shidian reply Gastroenterology and Hepatology
It is recommended to use antiviral medications long-term (such as Baraclude or Hepsera) and to undergo regular ultrasound monitoring.