Who performs Transjugular Intrahepatic Portosystemic Shunt (TIPS) surgery?

From the Guidelines

Transjugular Intrahepatic Portosystemic Shunt (TIPS) surgery is performed by interventional radiologists. During a TIPS procedure, the radiologist creates a new pathway between the portal vein and hepatic vein in the liver using a metal stent, which helps reduce portal hypertension by redirecting blood flow 1. This procedure is typically performed in a hospital's interventional radiology suite under moderate sedation or general anesthesia. The interventional radiologist uses fluoroscopy (real-time X-ray) and ultrasound guidance to access the jugular vein in the neck, then navigate through blood vessels to reach the liver where they create the shunt.

Key Points to Consider

• TIPS is commonly used to treat complications of portal hypertension such as recurrent variceal bleeding or refractory ascites in patients with liver cirrhosis 1.
• While gastroenterologists, hepatologists, or surgeons may refer patients for TIPS, the actual procedure requires the specialized skills of an interventional radiologist who has expertise in both vascular interventions and liver anatomy 1.
• A team-based approach to TIPS is critical in all stages of TIPS planning and management, involving the patient, caregiver, gastroenterologist or hepatologist, and a proceduralist with competency in TIPS, as well as additional specialties as needed 1.

Procedure Details

• The procedure involves creating a new pathway between the portal vein and hepatic vein in the liver using a metal stent.
• The interventional radiologist uses fluoroscopy and ultrasound guidance to access the jugular vein in the neck and navigate through blood vessels to reach the liver.
• The procedure is typically performed under moderate sedation or general anesthesia in a hospital's interventional radiology suite.

Importance of Specialized Skills

• The actual TIPS procedure requires the specialized skills of an interventional radiologist with expertise in both vascular interventions and liver anatomy 1.
• This expertise is crucial for optimal outcomes and minimizing complications.

From the Research

Transjugular Intrahepatic Portosystemic Shunt (TIPS) Procedure

The TIPS procedure is typically performed by:

• Interventional radiologists, as evidenced by the technical aspects of the procedure described in 2
• Medical professionals in a hospital setting, such as a quaternary liver transplant hospital, as mentioned in 2
• Surgeons, as implied by the discussion of surgical portacaval shunts in 3 and the role of surgeons in transplantation procedures in 4

Key Points

• The TIPS procedure is used to treat complications of portal hypertension, including refractory ascites and variceal bleeding, as stated in 5, 4, and 6
• The procedure involves the creation of a shunt between the portal and hepatic veins, as described in 5 and 2
• While the procedure is generally safe, it can be associated with complications such as encephalopathy, liver failure, and shunt dysfunction, as discussed in 6 and 3

Performance of TIPS

• The performance of TIPS requires specialized training and equipment, as implied by the discussion of technical aspects of the procedure in 2
• The procedure is typically performed in a hospital setting with access to fluoroscopy and other imaging modalities, as mentioned in 2
• The use of ultrasound guidance during TIPS is a technique that has been described in the literature, as evidenced by 2