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International Health - Centers of Excellence: TIPS (transjugular intrahepatic portosystemic shunt)

Overview

TIPS is an interventional radiologic technique for treating complications of portal hypertension. In particular the purpose of this procedure is to decompress the portal system (decrease the pressure in the portal system). This is a less invasive alternative to traditional surgical portosystemic shunts. By decreasing the pressure in the portal vein, the TIPS procedure effectively treats variceal bleeding and intractable ascites which are the main complications of portal hypertension caused by liver disease.

Number of Procedures

At the Washington University Department of Radiology (Mallinckrodt Institute of Radiology), approximately 70 TIPS per year are performed. We started doing this procedure shortly after its initial development and since 1991 we have done 580 TIPS procedures which is one of the larger experiences in the US.

Best Candidates

Primary candidates for this procedure are patients who have failed traditional endoscopic management of variceal bleeding or patients that are failing conservative medical management for ascites. Optimal candidates are patients who are candidates for liver transplantation although the procedure can also be done on patients who are ineligible for transplantation.

A patient should have reasonable liver function. If the patients liver failure is bad enough that they are close to complete liver failure, the TIPS procedure can push the patient into complete liver failure. The patient should also have reasonable right heart function. Having a patent (open) portal vein also makes the procedure easier but some patients with portal vein thrombosis are still candidates.

Specialized Services

Given the large experience in TIPS, the physicians in the department have experience dealing with difficult clinical situations that other medical centers would not handle. These include TIPS in patients with portal vein occlusion, TIPS in patients who also have liver cancers in addition to cirrhosis, and a variety of other situations.

The interventional group has been involved in both of the large multicenter trials geared towards determining safety and efficacy of devices used for TIPS. Based on the experience from the most recent FDA trial, the physicians here at Washington University have extensive experience using stent grafts to create more durable TIPS.

Key Physicians

Michael Darcy, M.D.
Craig Glaiberman, M.D.
Daniel Picus, M.D.
David Hovsepian, M.D.
Suresh Vedantham, M.D.
Daniel Brown, M.D.
Jennifer Gould, M.D.
James Duncan, M.D., Ph.D.

Team Approach

Interventional Radiology works very closely with the Hepatology and Liver Transplant sections. There is close communication regarding which patients are appropriate candidates. There is also close coordination during follow-up of patients after the TIPS procedure. The Interventional Radiology section follows TIPS patients to ensure proper functioning of the shunt.

Advantages

1. Interventional radiologists with a high level of technical and clinical expertise.
2. One of the largest TIPS experiences in the country.
3. Close coordination between Interventional Radiology, Hepatology, and Transplant Surgery.

International Referrals

International Health - Centers of Excellence: Aneurysms