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Liver

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

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What is TIPS?

TIPS is an abbreviation for a procedure that helps correct blood flow problems in the liver. It stands for:

  • Transjugular – across the jugular vein (vein in the neck)
  • Intrahepatic – within the liver
  • Portosystemic – from the portal vein to the general circulation (the portal vein is the main vein that carries blood from the stomach and intestines to the liver)
  • Shunt – a channel for blood to flow

TIPS is a method to decrease high blood pressure in the vein that brings blood into your child’s liver (hepatic portal vein). This vein carries blood to your child’s liver from the esophagus, stomach and intestines. High blood pressure in this vein (portal hypertension) can lead to serious problems with bleeding in these other organs.

In TIPS, doctors connect your child’s portal vein to one of the veins that carry blood from the liver to the heart (hepatic veins). The connection is called a shunt. The shunt means some blood from your child’s portal vein doesn’t have to pass through the liver. Instead, the blood goes straight to the hepatic vein. Because less blood has to enter the liver, the pressure in the portal vein goes down.

Before TIPS, your child gets general anesthesia. The doctor makes a small cut (incision) in your child’s groin or neck. A thin tube (catheter) is put through the incision into a large vein. The doctor threads the catheter through your child’s network of veins to their liver. Using the catheter, the doctor makes a tunnel through the liver. The tunnel connects the portal and hepatic veins. A mesh tube (stent) made of metal is placed in the tunnel to hold it open so blood can flow through.

The process is guided by an X-ray. It’s done by an interventional radiologist, and it takes three to four hours.

Why is TIPS done?

TIPS is done most often for children who have liver disease leading to liver failure and who are waiting for a transplant. Liver disease may raise the pressure in the portal vein, usually because scarring in the liver slows down blood flow through this organ.

High pressure in the portal vein can make blood back up in the veins of your child’s esophagus, stomach and intestines. Extra blood makes the veins swell. Swollen veins (varices) raise the risk that your child will bleed in these organs, which can be serious.

High pressure in the portal vein can also make fluid build up in your child’s belly (ascites) or chest (hydrothorax). This can cause swelling of the belly and make it hard to breathe.

TIPS lowers the pressure in the portal vein, so it lowers your child’s risk of bleeding or having fluid build-up. Your child might need TIPS if they have already had one or both of these problems. TIPS helps prevent the problems from happening again.

Instead of using the TIPS method, a surgeon can make an incision in your child’s belly (open surgery) and surgically connect the splenic vein (a branch of the portal vein) to the renal vein coming from the kidney, which then flows directly back to the heart without having to go through the liver. This method of making a shunt doesn’t use a stent, so children who have this method do not need procedures later to widen a narrow stent. Open surgery may be a better option than TIPS for some children – mainly those who will need their shunt for the rest of their life.

Some children cannot have the open surgery because of how poorly their liver works. TIPS gives these children an option while they wait for a liver transplant. For some children, TIPS works well enough that they don’t need a transplant as urgently as before. Another benefit of TIPS is that your child will probably recover faster than they would from open surgery.

What's special about the experience at Seattle Children's Hospital?

Seattle Children’s has the only liver program and only liver transplant program in the Northwest especially for children. We are also the only hospital in the Northwest that does TIPS for children.

Using this method, we have lowered portal hypertension and bleeding for many patients. Sometimes their condition becomes stable for a long time and we can delay the need for a transplant.

Who’s on the team?

Dennis W. Shaw, MD, performs TIPS at Children's.

Our patients who have TIPS are also cared for by these doctors:

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