TIPS: Treating Liver Disease with Alternative Means

The following was written by Jeanne M. Laberge, M.D., a Professor in Residence in the Department of Radiology and Biomedical Imaging at UCSF.

Transjugular Interhepatic Portosystemic Shunts, or “TIPS,” is now a common alternative treatment for patients with cirrhosis and other forms of advanced liver disease. UCSF was very active in the initial research into TIPS, and we continue to be involved in researching who will benefit the most from this procedure.

Two symptoms of advanced liver disease are internal bleeding and ascites, the buildup of fluid in the abdomen.  Both of those are medical problems that can be treated with TIPS as an alternative to a surgical shunt—a lengthy and complex operation where surgeons tie together two veins in the abdomen, leaving a large midline scar.  The conventional surgical shunt requires many hours of operative repair and several weeks of post-operative recuperation.

The TIPS procedure is a minimally-invasive therapy that is performed by an interventional radiologist, a doctor who is fully trained in all of the diagnostic imaging technology that is required of a radiologist, and who also has special training to learn how to use imaging guidance to do non-operative surgical procedures.

TIPS is very much like a surgical shunt procedure, but it can be done without an open operation and takes only one to two hours.  With the patient asleep, the interventional radiologist makes a small incision above the collarbone and, with imaging guidance, advances a catheter with tiny needles and graft material through a vein in the neck down to the liver.  The radiologist then creates a shunt—a channel in the liver to keep a wide open pathway between a vein in the liver and the vein that drains the liver—to try to reduce the blood pressure in the area, which will stop the bleeding.

After the procedure the patient remains in the hospital overnight with just a small tube coming out of the vein in the neck.  If everything is right the next day, the tube is removed and the patient is left with a small skin nick that is no thicker than the width of two dimes.  The patient can resume normal activities a day or two after the procedure.

TIPS is most beneficial for patients with advanced liver disease who are at high risk to undergo an operation.  These include patients with active bleeding in the liver; in those cases TIPS is a lifesaving procedure because TIPS can stop the bleeding without open surgery.

For a patient with a buildup of ascites fluid in their abdominal cavity TIPS will help reduce the fluid in the abdomen, which will improve the patient’s overall nutrition and help them feel better.

Many of the patients we see with advanced liver disease are also candidates for liver transplantation.  We have a very active liver transplantation unit at UCSF, with world-renowned liver transplant surgeons and hepatologists.  Using this TIPS procedure, we work with the physicians in the liver transplantation unit to help stabilize patients who have severe liver disease but aren’t quite ready for a liver transplant.

Learn more about liver treatments at UCSF here!