Transjugular Intrahepatic Porto systemic Shunts (TIPS) and Surgical Shunts
Transjugular Intrahepatic Porto systemic Shunts and Surgical Shunts. The pressure inside the portal venous system draining blood into the liver can be relieved by shunting blood away from these veins. Surgical portocaval shunts require an abdominal incision followed by sewing together a portion of the portal venous system to the main venous system. Often these two structures are connected using a short piece of tubing made of Teflon. The surgical shunts are effective at reducing the risk of bleeding from varices. Most surgical shunts will also relieve ascites. The main drawback of surgical shunts is that they are major vascular surgery, and may be associated with a high risk of complications in some patients.
Unlike surgical shunts, TIPS is performed through a small nick in the skin, working through specialized instruments, which are passed through the body using an x-ray camera for guidance. The TIPS procedure creates a shunt within the liver itself, by linking the portal vein with a vein draining away from the liver (a hepatic vein) together with a device called a stent-graft. The stent-graft acts as a scaffold to support the connection between these two veins inside the liver. With the TIPS stent-graft in place, the pressure inside the portal veins is relieved by the blood draining through the stent-graft into the vein draining blood away from the liver.