TIPSS procedure is commonly performed in the following patients
- Chronic liver disease (cirrhosis) patients presenting with vomiting of blood from engorged vessels (varices) in the stomach or food pipe. This procedure may be performed either as emergency lifesaving procedure or electively to prevent bleeding episodes.
- Cirrhotic patients with rapid build-up of fluid collection in the abdomen (ascites) or chest requiring repeated drainage tube insertion for fluid removal.
In this procedure, an artificial bypass channel is created between the portal vein and the hepatic vein. It is done to divert the blood from portal vein directly to the hepatic vein and thereby reduce the blood pressure in the portal vein. This is performed by an experienced interventional radiologist as this is a quite complex and risky procedure in these fragile patients with liver disease.
This procedure is done using X-ray guidance in the angiography suite from inside the blood vessel. The patient will be put to sleep by the anaesthetist. The interventional radiologist accesses a vein in the right side of the neck using a tiny skin incision. A catheter (fine tube) is introduced in to the hepatic vein which is inside the liver. Through the catheter a long thin curved needle is carefully passed out of the hepatic vein through the liver tissue to enter the portal vein under X-ray guidance. Once this is done, a wire is passed through the needle from the hepatic vein in to the portal vein. Then over the wire, a balloon is inflated within the liver between the two vessels to create space for placing a special stent graft. The stent graft is a flexible hollow tube made of thin metallic wire mesh lined on the outside by special material (eg.polytetrafluoro ethylene) which makes it impervious.