Transjugular intrahepatic portosystemic shunt
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2008-06-27T01:02:04Z
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Reverted edits by [[Special:Contributions/152.132.9.129|152.132.9.129]] to last version by 157.139.26.14 (using [[WP:HG|Huggle]])
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A '''transjugular intrahepatic portosystemic [[shunt_(medical)|shunt]]''', also '''TIPS''', is an artificial channel in the [[liver]] from the [[portal vein]] to a [[hepatic vein]] (for [[blood]]). It is created [[endovascular procedure|endovascularly]] (via the [[blood vessel]]s) by [[physician]]s via the [[jugular vein]].
It is used to treat [[portal hypertension]] (which often is due to scarring of the liver ([[liver cirrhosis]])) which frequently leads to intestinal bleeding ([[esophageal varices]]) or the buildup of fluid within the abdomen ([[ascites]]).
==Mechanism of action==
A TIPS decreases the effective [[vascular resistance]] of the liver. The result is a reduced [[pressure drop]] over the liver and a decreased portal venous pressure. This, in turn, lessens the pressure on the blood vessels in the intestine so that future bleeding is less likely to occur. The reduced pressure also makes less fluid develop, although this benefit may take weeks or months to occur.
==Implantation==
Transjugular intrahepatic portosystemic shunts are typically placed by [[interventional radiologist]]s under [[fluoroscopy|fluoroscopic]] guidance.<ref>What You Need to Know about the Transjugular Intrahepatic Portosystemic Shunt (TIPS). Cleveland Clinic. URL: [http://www.clevelandclinic.org/health/health-info/docs/0200/0237.asp?index=4956 http://www.clevelandclinic.org/health/health-info/docs/0200/0237.asp?index=4956]. Accessed: February 19, 2007.</ref> Access to the liver, as the name ''transjugular'' suggests, is gained via the [[jugular vein]] in the [[neck]]. Once access to the jugular vein is confirmed, a guidewire and introducer sheath is typically placed to facilitate the [[shunt_(medical)|shunt]]'s placement. This enables the interventional radiologist to gain access to the patient's liver vein (hepatic vein) by passing through the heart. The shunt is created by advancing a special needle through the sheath system to connect the hepatic vein to the large vein near the center of the liver, the [[portal vein]]. The channel for the shunt is next created by inflating an angioplasty balloon within the liver along the tract of created by the needle. The shunt is completed by placing a special mesh tube known as a [[stent]] or [[endograft]] to establish the connection between the high pressure portal vein with the lower pressure hepatic vein. After the procedure, fluoroscopic images are made to show placement and [[pressure]] measurements in the portal vein and inferior vena cava are often done.
==Use in hepatorenal syndrome==
TIPS has shown some promise for patients with [[hepatorenal syndrome]].<ref>Guevara M, Rodes J. Hepatorenal syndrome. Int J Biochem Cell Biol. 2005 Jan;37(1):22-6. PMID 15381144.</ref>
==Complications==
A complication of [[umbilical hernia]] has been recently reported.<ref name="pmid17825762">{{cite journal |author=Mallavarapu RK, Grimsley EW |title=Incarcerated umbilical hernia after transjugular intrahepatic portosystemic shunt procedure for refractory ascites |journal=Clin. Gastroenterol. Hepatol. |volume=5 |issue=9 |pages=A26 |year=2007 |pmid=17825762 |doi=10.1016/j.cgh.2007.07.018}}</ref>
==See also==
*[[Portal venous system]]
*[[Distal splenorenal shunt procedure]]
*[[Interventional radiology]]
==References==
<references/>
==External links==
*[http://www.radiologyinfo.org/en/info.cfm?pg=tips RadiologyInfo: Transjugular Intrahepatic Portosystemic Shunt (TIPS)]
*[http://www.emedicine.com/radio/topic764.htm Transjugular Intrahepatic Portosystemic Shunt] - eMedicine.com.
* A [http://www.med.umich.edu/1libr/aha/umliver09e.gif schematic representation of a TIPS] - [[University of Michigan]].
[[Category:Medical treatments]]
[[Category:Gastroenterology]]
[[Category:Hepatology]]
{{Vascular surgery procedures}}
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