TIPS Procedure
Learn about the TIPS procedure in Singapore, a minimally invasive treatment provided by Dr. Manish Taneja from the Supreme Vascular and Interventional Clinic that reduces portal pressure for selected patients with portal hypertension.
Transjugular Intrahepatic Portosystemic Shunt (TIPS) in Singapore
Minimally Invasive Treatment for Portal Hypertension
Transjugular Intrahepatic Portosystemic Shunt (TIPS) is a minimally invasive, image-guided procedure used to reduce pressure within the portal venous system in selected patients with complications of portal hypertension.
Portal hypertension occurs when blood pressure becomes abnormally high within the portal vein system, which carries blood from the digestive organs to the liver.
TIPS creates a new channel within the liver connecting the portal vein to a hepatic vein. A stent is placed within this channel to allow blood to bypass part of the liver and reduce portal venous pressure.
TIPS may be considered for selected patients with complications such as recurrent variceal bleeding or refractory ascites.
At the Supreme Vascular and Interventional Clinic, treatment is planned according to your underlying condition, liver function, imaging findings and overall health.
Care is led by Dr. Manish Taneja, providing specialist vascular and interventional expertise with a continuum of care under one roof.
Treatment Overview
| Treatment Type | Minimally invasive image-guided vascular procedure |
|---|---|
| Commonly Used for | Selected complications of portal hypertension |
| Treatment goal | Reduce pressure within the portal venous system |
| How It Works | Creates a channel between the portal and hepatic veins |
| Device Used | Specialised covered stent |
| Imaging Guidance | Ultrasound, fluoroscopy and venography |
| Access | Usually through a vein in the neck |
| Anaesthesia | Usually performed with appropriate sedation or anaesthesia |
| Follow-Up | Regular clinical and imaging follow-up |
| Performed By | Dr. Manish Taneja, dual-trained neurointerventional and peripheral vascular intervention specialist |
What Is TIPS?
TIPS stands for Transjugular Intrahepatic Portosystemic Shunt.
It is a minimally invasive procedure that creates a new pathway for blood to flow between the portal vein and hepatic vein within the liver.
The portal vein carries blood from the digestive system towards the liver. When pressure becomes too high within this system, blood can be diverted through smaller veins that are not designed to carry such large amounts of blood.
This can contribute to complications such as enlarged veins called varices, which may bleed.
TIPS creates a lower-resistance pathway for blood flow and can help reduce portal venous pressure.
How Does TIPS Work?
Creating a New Pathway Through the Liver
Your medical history, liver function and previous imaging are first reviewed.
The portal and hepatic veins are assessed to determine whether TIPS is appropriate.
A catheter is introduced through a vein in the neck. The catheter is guided through the venous system towards the liver.
A specialised needle is used to create a channel between a hepatic vein and the portal vein.
The new channel is expanded using a balloon. A covered stent is placed to keep the channel open.
Blood can then flow from the portal vein through the new pathway into the hepatic vein. The reduced resistance helps lower pressure within the portal venous system.
What Is Portal Hypertension?
Understanding High Pressure in the Portal Venous System
Portal hypertension refers to abnormally high pressure within the portal venous system. It can occur when blood encounters increased resistance passing through the liver.
One of the common causes is advanced liver disease and cirrhosis.
Portal hypertension can contribute to complications including:
- Oesophageal varices
- Gastric varices
- Variceal bleeding
- Ascites
- Enlarged abdominal veins
- Other complications related to abnormal portal blood flow
The appropriate treatment depends on the underlying cause and individual circumstances.
When Might TIPS Be Considered?
TIPS may be considered for selected patients with complications of portal hypertension.
Potential indications include:
- Recurrent or uncontrolled variceal bleeding
- Variceal bleeding that has not responded adequately to other treatments
- Refractory ascites
- Selected cases of hepatic hydrothorax
- Other complications of portal hypertension in carefully selected patients
TIPS is not appropriate for every patient with liver disease or portal hypertension.
A detailed assessment is required before treatment.
TIPS for Variceal Bleeding
Reducing Pressure Within the Portal System
Varices are enlarged veins that can develop when blood is diverted away from the liver because of portal hypertension.
Oesophageal or gastric varices can become fragile and may bleed. TIPS creates an alternative pathway for blood to flow through the liver, reducing pressure within the portal venous system.
This can help reduce the pressure driving blood through the varices.
TIPS may therefore be considered when variceal bleeding is difficult to control or continues to recur despite other treatments.
TIPS for Refractory Ascites
Helping Manage Fluid Accumulation
Ascites refers to the accumulation of fluid within the abdomen.
Portal hypertension and advanced liver disease can contribute to the development of ascites.
Some patients develop ascites that becomes difficult to control despite medication and other treatments.
In selected cases, TIPS may help reduce portal pressure and improve the underlying circulatory imbalance contributing to fluid accumulation.
Whether TIPS is appropriate depends on liver function, kidney function, heart health and other individual factors.
Potential Benefits of TIPS
A Minimally Invasive Approach to Portal Hypertension
For appropriately selected patients, TIPS may offer several potential benefits.
Minimally Invasive
TIPS is performed through a catheter rather than open abdominal surgery.
Reduces Portal Pressure
The shunt provides an alternative pathway for portal blood flow and can reduce pressure within the portal venous system.
Helps Control Variceal Bleeding
Reducing portal pressure can help lower the risk of recurrent bleeding from varices.
May Improve Refractory Ascites
TIPS can help manage ascites in selected patients who have not responded adequately to other treatments.
No Major Abdominal Incision
The procedure is performed through venous access, usually through the neck.
Image-Guided Precision
Ultrasound and X-ray imaging are used to guide creation of the shunt and placement of the stent.
TIPS vs Other Treatments for Portal Hypertension
Understanding Your Treatment Options
The appropriate treatment depends on the specific complication and your overall health.
| Treatments | Primary Purpose |
|---|---|
| TIPS | Creates an alternative pathway to reduce portal venous pressure |
| Endoscopic Treatment | Treats or prevents bleeding from selected varices |
| Medication | Helps reduce portal pressure or manage associated complications |
| Paracentesis | Removes abdominal fluid in patients with ascites |
| Liver Transplantation | Treats selected patients with advanced liver disease |
These treatments may sometimes be used together as part of a broader management plan.
What Are the Potential Risks and Considerations?
Understanding What to Expect
As with any medical procedure, TIPS has some potential risks and considerations. These are generally discussed with you beforehand and monitored carefully during your care.
These may include:
- Temporary discomfort or bruising
- Minor bleeding around the access site
- Temporary changes in blood flow (Encephalopathy which is temporary and treatable with medications)
- Temporary changes in concentration or alertness in some patients
- Sensitivity or reaction to the contrast material
- Heart-related considerations in selected patients
- The possibility of needing further monitoring or treatment
Most of the complications are manageable and can be controlled. Your individual risks depend on your overall health, liver function and the reason TIPS is being considered. Your specialist will discuss these with you and explain how they can be monitored and managed.
A detailed assessment is performed before treatment to determine whether the potential benefits outweigh the risks.
Recovery After TIPS
What Can You Expect After Treatment?
A TIPS procedure has a success rate of 95%, and takes from 90 min to up to 3 hours to perform. TIPS generally requires hospital monitoring following the procedure. Your recovery depends on your underlying liver condition and the reason the procedure was performed.
After treatment, your medical team may monitor:
- Liver function
- Blood pressure
- Neurological symptoms
- The TIPS stent
- Portal blood flow
- Fluid balance
- Any signs of bleeding or infection
Regular follow-up imaging is important to confirm that the TIPS remains open and functioning properly.
Typical hospital stay is 1-3 days after the procedure. Up to 1 in 3 persons who have TIPS have encephalopathy or mental confusion. This can be treated with diet, medication or by revising the shunt. Patients are also placed on follow-up ultrasounds to check stent patency, as there is always a small chance of stent getting narrowed or blocked, which can be fixed.
Your specialist will provide personalised follow-up instructions based on your condition.
Your TIPS Treatment Journey
| Step | Stage | Description |
|---|---|---|
| 1 | Specialist Assessment | Review your liver condition, portal hypertension and previous investigations. |
| 2 | Clinical Evaluation | Assess your liver function, overall health and suitability for TIPS. |
| 3 | Imaging Assessment | Evaluate the portal and hepatic veins and relevant abdominal anatomy. |
| 4 | Treatment Planning | Determine whether TIPS is appropriate and plan the safest approach. |
| 5 | Venous Access | Introduce a catheter through a vein in the neck. |
| 6 | Shunt Creation | Create a channel between the hepatic vein and portal vein within the liver. |
| 7 | Stent Placement | Place a covered stent to keep the new pathway open. |
| 8 | Flow Assessment | Use imaging to confirm appropriate blood flow through the new shunt. |
| 9 | Recovery & Monitoring | Monitor your condition and arrange appropriate follow-up imaging. |
Why Choose the Supreme Vascular and Interventional Clinic
Specialist-Led, Minimally Invasive Vascular Care Under One Roof
TIPS is an advanced procedure that requires detailed understanding of the portal and hepatic venous systems.
At the Supreme Vascular and Interventional Clinic, treatment planning considers your underlying liver condition, imaging findings, vascular anatomy and overall health.
Care is led by Dr. Manish Taneja, providing specialist vascular and interventional expertise with continuity of care under one roof.
Brain-to-Body Expertise
Dr. Manish Taneja's expertise spans neurointerventional and peripheral vascular intervention, providing broad experience in image-guided procedures involving blood vessels throughout the body.
Minimally Invasive Approach
TIPS is performed through venous catheter access rather than conventional open surgery.
Image-Guided Precision
Ultrasound, fluoroscopy and venography help guide the creation of the shunt and placement of the stent.
Individualised Treatment Planning
The decision to perform TIPS depends on your liver function, portal hypertension, underlying condition and overall health.
Complex Vascular Expertise
TIPS requires careful assessment of the portal and hepatic venous circulation and precise catheter-based intervention.
Continuum of Care
From specialist assessment and imaging through treatment planning, intervention and follow-up, the Supreme Vascular and Interventional Clinic provides continuity of specialist care under one roof.
Frequently Asked Questions About TIPS
What is TIPS?
TIPS stands for Transjugular Intrahepatic Portosystemic Shunt and is a minimally invasive procedure that creates a pathway between the portal and hepatic veins.
What is TIPS used for?
TIPS is primarily used to manage selected complications of portal hypertension, including recurrent variceal bleeding and refractory ascites.
How does TIPS reduce portal pressure?
TIPS creates a lower-resistance pathway for blood to flow from the portal vein into the hepatic vein, reducing pressure within the portal venous system.
Where is TIPS performed?
The procedure is performed within the liver using catheter access through a vein, usually in the neck.
Is TIPS open surgery?
No. TIPS is a minimally invasive catheter-based procedure performed using image guidance.
How long does TIPS take?
The procedure duration varies depending on the patient's anatomy and clinical circumstances.
Is TIPS suitable for everyone with portal hypertension?
No. Suitability depends on the underlying liver disease, portal hypertension, liver function, heart health and other individual factors.
Can TIPS stop variceal bleeding?
TIPS can help control or prevent recurrent variceal bleeding in appropriately selected patients by reducing portal venous pressure.
Can TIPS treat ascites?
TIPS may help manage refractory ascites in selected patients when other treatments have not provided sufficient control.
What is hepatic encephalopathy after TIPS?
Hepatic encephalopathy is a condition involving changes in brain function that can occur when blood bypasses some of the liver's normal filtering process.
Does a TIPS stent need monitoring?
Yes. Follow-up imaging is important to assess blood flow through the TIPS and check that the stent remains functioning properly.
Specialist Assessment for TIPS in Singapore
Portal hypertension can cause serious complications, including variceal bleeding and fluid accumulation in the abdomen. TIPS provides a minimally invasive way of reducing portal venous pressure for carefully selected patients when other treatments may not provide sufficient control. At the Supreme Vascular and Interventional Clinic, Dr. Manish Taneja provides specialist vascular and interventional assessment for patients who may benefit from advanced image-guided treatment.
With expertise spanning the brain and body, the Supreme Vascular and Interventional Clinic provides a continuum of specialist care from assessment and imaging through treatment planning, minimally invasive intervention and follow-up under one roof. If you have portal hypertension or complications such as recurrent variceal bleeding or refractory ascites, a specialist assessment can help determine whether TIPS may be appropriate for your individual circumstances.
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