Transjugular Intrahepatic Portosystemic Shunt

What is a T.I.P.S procedure?
T.I.P.S stands for Transjugular Intrahepatic Portosystemic Shunt. A stent/shunt is placed to allow blood to flow from the portal venous system through the hepatic venous system thereby relieving the complications of portal hypertension.

Why do I need a T.I.P.S?
T.I.P.S is performed to treat variceal bleeding secondary to portal hypertension. Patients that have cirrhosis of the liver often develop esophageal varices and portal hypertension. If this is left untreated, internal bleeding may occur.

How do I prepare for a T.I.P.S?
Inpatients: Your nurses and doctors will give you instructions on how to prepare for you T.I.P.S procedure.

Outpatients or those being admitted on the morning of your T.I.P.S procedure: You should follow the instructions below:

1. Do not eat any solid food after midnight on the night before your procedure. You may drink clear fluids and take your medications.
2. If you are diabetic and take insulin, ask your doctor about modifying your insulin dose for the day of your procedure.
3. If you take the blood thinner Coumadin, you must tell your doctor so that it can be stopped appropriately. Bring all your medications with you.
4. If you are allergic to contrast (x-ray dye) or iodine, let your doctor know as soon as possible. Your doctor can let the interventional radiologist know about your allergy a few days before your T.I.P.S and steps can be taken, if necessary, to pre-medicate you.

Everyone having a T.I.P.S procedure will have blood tests. As an outpatient, your blood tests will be done two hours before your procedure. After you arrive in Outpatient Registration (or before you come to the x-ray department if you are an inpatient), you will dress in a hospital gown and an intravenous (IV) line will be placed in one of your veins. This will be used to give you fluids and medicines during the procedure. The IV will stay in place until after you procedure is completed. The doctor will determine when it can be discontinued. The T.I.P.S procedure usually takes 2-4 hours to complete.

What will I experience?
This procedure has five major steps:

1. IV sedation:
   Medication will be administered using the IV that has been placed prior to your test.
2. Catheter insertion:
   The interventional staff will wash the skin where the catheter will be inserted and at times this may involve shaving off the hair of that small specific area. The area is usually at the right side of the neck. The radiologist will use a local anesthetic (similar to what your dentist uses to numb your mouth) in the skin and deeper tissues. After that, you should only feel pressure when the catheter is inserted into the vein in the numbed area. Using an x-ray screen-like a TV, the radiologist will guide the catheter through your body to the vein that is in your liver.
3. Contrast injection:
   After the catheter is placed into the vein (in the liver), contrast will be injected through that catheter while x-ray pictures are being taken. You may feel warm inside while the contrast is being injected, but it lasts only a few seconds. Usually, several contrast injections and x-rays are needed to complete the exam.
4. Placement of a metallic stent in the liver:
   You will feel pressure in the liver area, while a catheter with a balloon on the end is used to predilate the tract. The balloon catheter is then exchanged for a catheter with a stent on the end. During the exchanging of the catheters, you will feel pressure at the right side of your neck. Finally, the stent(s) are placed in the liver to provide maximum patency and flow.
5. Removal of the catheter:
   After the procedure is completed and all x-rays are taken, a member of the radiology interventional team (radiologist, nurse, or technologist) will remove the catheter from your vein. Removing the catheter should not hurt. Firm pressure will be put on the place the catheter was inserted for 10-20 minutes. This will stop the vein from bleeding.

What do I do after my T.I.P.S procedure?
In most cases, you will stay in the hospital after your T.I.P.S procedure. If you are an Outpatient: You will be assigned a room to stay in for 6-12 hours after the T.I.P.S. Hospital staff will watch over you to make sure you are all right. After this observation period is over you will be allowed to go home if the doctor says it is all right. Have someone drive you home after the procedure. You may not drive yourself home.

After you go home:

1. Relax and take it easy for 24 hours.
2. Drink plenty of fluids.
3. Resume your regular diet unless your doctor specifies otherwise.
4. Keep a bandage on the catheter insertion site for a day.
5. Do not drive or run machinery for at least 24 hours.
6. Do not do any strenuous exercise or lifting for at least two days.
7. Do not take a hot bath or shower for at least 12 hours.
8. Do not smoke for at least 24 hours.

What are some potential complications associated with this procedure?
Two potential complications are stent migration (shifting of the sten) and encephalopathy (disorientation due to blood flow changes).

Please review this information.
During your visit, you will meet with highly trained, dedicated professionals who will strive to make your procedure as brief and as comfortable as possible. If you have any further questions, ask a member of our staff.

Your Radiologist
The vascular interventionalists at Mid-South Imaging & Therapeutics perform a wide range of procedures such as monitoring blood flow, "balloon angioplasty" to open clogged blood vessels in the limbs, closing off flow to blood vessel tumors, obtaining biopsies through needles, draining infections, and many more.

Your radiologist is a licensed, board-certified physician with special fellowship training in vascular interventional procedures.

Who is Mid-South Imaging & Therapeutics?
Mid-South Imaging & Therapeutics, P.A., is one of the largest and most specialized radiology groups in the Mid-South, providing imaging services for Baptist Memorial Hospitals for more than four decades. The board-certified physicians employ state-of-the-art technology and diagnostic equipment in providing consultation and procedural services. We are also active in national research programs.

What is interventional radiology?
It is a specialty of radiology in which radiologists diagnose and/or treat diseases without surgery, by guiding tiny tubes through your body's arteries and organs. This allows the radiologists to place medications directly at the organ site, open blocked blood vessels, drain an obstructed kidney, obtain biopsies, and perform many other procedures-using x-rays and other radiologic equipment to guide them.

How can an interventional radiologist help me?
An interventional radiologist performs procedures to treat problems in the arteries, kidneys, liver and the internal organs that might otherwise be treated by surgery.

Why have I been placed under your care?
Your physician referred you to us, asking us to handle the specialized procedure you need. All procedures are done by one of our interventional radiologists who then reads and interprets the results. The radiologist reports the findings directly to your physician, working together as a team to help you receive the best possible care.

How will I get my procedure results?
You will always remain under the care of your primary physician, who will notify you of the results of your procedure. However, one of our nurses will follow-up with you on your specific interventional treatment, for check-up appointments and to provide information about follow-up care. Your medical records for the procedure remain in our files, with copies sent to your primary physician.

How will payment be handled?
After your procedure is complete, our business office personnel will file a claim with your insurance company for the charges. This claim is separate from the bill you receive from the hospital and your primary physician. You will be notified about the insurance payment and your financial responsibility for the radiology treatments. If you have any questions about your Mid-South Imaging & Therapeutics bill, call 901-383-8860 or 1-800-467-6988.

For questions concerning your treatment or follow-up care day or night: call 901-747-1007 or 662-772-2273.