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Transjugular Intrahepatic Portosystemic Shunt Treatment in Dhakuria

TIPS for Portal Hypertension

TIPS Treatment for Portal Hypertension in Dhakuria

TIPS, or Transjugular Intrahepatic Portosystemic Shunt, is a minimally invasive surgery in which imaging guidance is used to connect two big veins in the liver, the portal and hepatic vein. This helps blood bypass the faulty liver and return to the heart more easily. A little metal device known as a stent is used to keep the connection open.

TIPS is used to limit the risk of internal bleeding from the stomach and oesophagus in patients with cirrhosis. TIPS may also help to minimise the accumulation of fluid in the abdomen and lungs. A TIPS stent permits blood coming into the liver from the portal vein to pass straight into the hepatic vein, which empties blood from the liver to the vena cava and eventually into the heart. TIPS is used to treat individuals with portal hypertension and its related complications (variceal haemorrhage, portal hypertension gastropathy, and severe ascites) and, in some situations, Budd-Chiari syndrome.

For guidance, fluoroscopy is used in TIPS surgery, which helps in the precise placement of the stent while minimising the need for open surgery. This procedure is typically performed by an interventional radiologist and offers a less invasive alternative to traditional surgical approaches, leading to shorter recovery times and improved patient outcomes.

FAQ's

The most common cause of portal hypertension is liver cirrhosis. Long-term liver disease produces scarring in your liver tissues. Scar tissue blocks the flow of blood through the portal vein that runs through your liver.

TIPS surgery is needed for the following reasons:

  • Ascites are fluid accumulations in the abdomen that cannot be treated by dietary salt restriction and diuretics ("water pills"). Ascites can cross the diaphragm muscle between one of the lungs and the belly, filling the area around the lung, usually the right lung.

  • Hepatic hydrothorax is a condition that TIPS can typically help with. TIPS should not be considered if fluid buildup can be managed with dietary salt reduction and diuretics.

  • Bleeding is caused by varices (swollen veins in the oesophagus or stomach) that cannot be managed with endoscopic procedures such as Rubber Band Ligation. Rubber Band Ligation is less effective for bleeding varices in the stomach, rectum, or elsewhere; therefore, a TIPS is frequently required in these cases.

There are two primary risks with the TIPS technique:

  • Confusion is a disorder characterised by altered mental status and is thought to be caused by toxic chemicals from the intestines (ammonia). The liver generally removes ammonia from the bloodstream. TIPS allows toxic blood containing ammonia to bypass your liver. This could alter your brain in a way that causes confusion or even a comma. A variety of treatments can be used to address this problem.

  • Heart failure occurs when there is an increase in the quantity of blood returning to the heart via the shunt, or TIPS. The heart may not be able to return blood to your body quickly enough, resulting in heart failure. If you have a history of heart failure, notify your doctor before undergoing the surgery.

The primary reasons why a TIPS should not be performed are:

  • TIPS has such low liver function that it can lead to additional liver failure. A TIPS is a higher-risk procedure after the MELD (model for end-stage liver stage- a lab test score for surgery) score exceeds 15, and it is normally not performed if the MELD score exceeds 18–20 unless it is required in an emergency to prevent bleeding from varices and the person is on the liver transplant list.

  • The right side of the heart, which pumps blood through the lungs, is not strong enough to handle the additional blood flow, or if there is already severe hypertension in the lung circulation, the increased flow from the TIPS can put a burden on the heart. An echocardiogram is usually used to determine this prior to TIPS insertion.

  • TIPS is often not recommended to treat big varices in the oesophagus and stomach. Additionally, it’s not preferred if a blood clot blocks the portal vein or if there is the presence of liver cancer or other types of cancer inside the liver.

Maintaining good food habits and living a healthy lifestyle may help you avoid developing portal hypertension. To increase the function of your liver, you can do the following: Do not consume alcohol or illicit drugs.

While portal hypertension does not normally have a direct influence on fertility or pregnancy, underlying liver illness may. Women with liver disease should consult with their doctor about pregnancy planning, as pregnancy might increase liver-related issues. Furthermore, several drugs used to treat portal hypertension may be unsafe during pregnancy, necessitating therapy changes.

Chronic liver disease, including disorders that produce portal hypertension, such as liver cirrhosis, might increase the chance of developing liver cancer (hepatocellular carcinoma). Regular monitoring of liver cancer with imaging tests such as ultrasonography or MRI is critical for early identification and treatment.

Beta-blockers can be used to reduce portal pressure; however, there are certain negative effects. If you have cirrhosis but no varices, beta blockers will not prevent varices from forming. Studies have demonstrated that the medication's adverse effects exceed its potential advantages.

While TIPS can significantly alleviate symptoms, it may not be a long-term cure for portal hypertension. Shunt function can fluctuate over time, and certain individuals may require extra procedures or changes to keep it functional.

Follow-up appointments are required to evaluate the operation of the shunt and examine your overall health. Your healthcare physician will set the frequency of follow-up visits depending on your specific needs, but regular check-ups are usually required to guarantee TIPS's long-term success.

Your doctor may offer drugs to treat specific symptoms of portal hypertension or to prevent consequences like infection or hepatic encephalopathy. It is critical that you strictly adhere to their drug management guidelines.

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