How will I know if I am a candidate for TIPS
How will I know if I am a candidate for TIPS, most patients with portal hypertension do not need to have a TIPS. Patients that have esophageal varices and problems with bleeding can often be managed with the drug therapy described above. However, for those patients that continue to be at risk for bleeding or who cannot tolerate the usual first-line treatments, TIPS may be an effective form of therapy. In patients with ascites who continue to form large amounts of fluids within their abdomen, even while taking water pills (diuretics), and who require frequent sessions of paracentesis to drain away the fluid, TIPS may also be a very effective therapy.
TIPS is performed by an Interventional Radiologist. The Interventional Radiologist will determine from your medical history, physical, blood work and liver imaging (CT scans, ultrasounds and/or MRI scans), in consultation with your gastroenterologist, hepatologist, or surgeon, whether or not you are a candidate for TIPS.
You should discuss all your treatment options with your physician. Some questions to ask include:
- Can my portal hypertension be controlled with drug therapy?
- What medications might be appropriate for me?
- If a procedure is required, am I a candidate for a less invasive, Interventional Radiology treatment like a transjugular intrahepatic portosystemic shunt?
- What are the risks and benefits of the treatment plan prescribed for me?
- What are the risks of TIPS?
Because blood that normally flows through the liver gets bypassed through a TIPS, some of the substances absorbed into the body from the intestines can build-up within the blood stream and produce a condition known as hepatic encephalopathy. This is a condition that can affect your brain, causing difficulty in concentration, excessive sleepiness and, in rare cases, a coma.
Most cases of hepatic encephalopathy are manageable by taking a medication known as lactulose. This is a laxative in a syrup form that reduces the amount of certain types of toxins absorbed by the intestines into the blood stream. In rare situations, a person can develop severe hepatic encephalopathy after TIPS. If this occurs, the TIPS may need to be closed off or a smaller stent placed within the original stent to slow down the amount of blood passing through the TIPS. Other risks of TIPS include hepatic failure, bleeding and infection.