Where does blood drain into in Transjugular Intrahepatic Portosystemic Shunt (TIPS)?

From the Guidelines

In a Transjugular Intrahepatic Portosystemic Shunt (TIPS), blood drains from the portal vein directly into the hepatic vein. This procedure creates an artificial channel within the liver that allows blood to bypass the liver's normal circulation. Specifically, the shunt connects the portal vein, which carries blood from the digestive organs to the liver, to the hepatic vein, which carries blood from the liver to the inferior vena cava and ultimately to the heart.

Key Points

• The goal of TIPS is to relieve the elevated portal pressures that cause the development of varices and subsequent pressurization, as noted in the study by 1.
• TIPS has been found to be superior for reduction of variceal bleeding compared to endoscopic/medical management, although it comes with a risk of hepatic encephalopathy, as reported in 1.
• The utilization of stent grafts for TIPS creation is expected to improve outcomes given their superior patency rates in randomized trials, as mentioned in 1.
• TIPS is an effective therapy to reduce portal pressure, halt active variceal bleeding, and prevent rebleeding, as stated in 1.

Clinical Implications

• By redirecting blood flow, TIPS reduces the pressure in the portal system, which helps prevent bleeding from esophageal or gastric varices and reduces the formation of ascites.
• However, this shunting means that some blood bypasses the liver's detoxification processes, which can potentially lead to complications like hepatic encephalopathy in some patients, as discussed in 1 and 1.
• The risks of TIPS, such as hepatic encephalopathy and hepatic ischemia, may be greater in the presence of a gastrorenal shunt, often associated with cardiofundal gastric varices, as noted in 1.

From the Research

Transjugular Intrahepatic Portosystemic Shunt (TIPS) Procedure

• The TIPS procedure involves creating a pathway from the portal vein to a hepatic vein or inferior vena cava through hepatic parenchyma, using a stent or stent graft to sustain patency of this pathway 2.
• Blood drains into the hepatic vein or inferior vena cava through this created pathway 2, 3.

Blood Drainage in TIPS

• The TIPS procedure allows blood to drain from the portal vein into the hepatic vein or inferior vena cava, reducing portal pressure 4, 5.
• The creation of a TIPS can help to prevent esophageal variceal rebleeding and/or refractory ascites in patients with portal hypertension 6, 4.

Anatomy and TIPS

• The anatomy of the hepatic veins and portal bifurcation can affect the creation of a TIPS, with some patients requiring a transcaval approach 3.
• The entry site into liver parenchyma from the inferior vena cava can be within 2 cm of the atriocaval junction 3.