What Is Portal Hypertension?
How Successful Is the TIPS Procedure?
The TIPS procedure controls bleeding immediately in more than 90% of patients with portal hypertension. However, in about 20% of patients, the shunt may narrow, causing varices to re-bleed at a later time.
What Complications Are Associated With TIPS?
Shunt narrowing or blockage can occur within the first year after the TIPS procedure. Follow-up ultrasound exams are performed frequently after the TIPS procedure to detect these complications. The signs of a blockage include increased ascites (accumulation of fluid in the abdomen) and re-bleeding. This condition can be treated by a radiologist who re-expands the shunt with a balloon or repeats the procedure to place a new stent.
Encephalopathy, or abnormal functioning of the brain, can occur with severe liver disease. Hepatic encephalopathy can become worse when blood flow to the liver is reduced by TIPS, which may result in toxic substances reaching the brain without being metabolized first by the liver. This condition can be treated with medications, diet, or by making the shunt inaccessible.
What Happens in the DSRS Procedure?
The DSRS is a surgical procedure during which the vein from the spleen (called the splenic vein) is detached from the portal vein and attached to the left kidney (renal) vein. This surgery selectively reduces the pressure in the varices and controls the bleeding associated with portal hypertension. It is usually performed only in patients with good liver function.
A general anesthetic is given before the surgery, which lasts about four hours. You should expect to stay in the hospital from seven to 10 days following surgery.
How Successful Is the DSRS Surgery?
The DSRS procedure provides good long-term control of bleeding in those with portal hypertension. DSRS controls bleeding in more than 90% of patients, with the highest risk of any re-bleeding occurring in the first month.
What Complications Are Associated With DSRS Surgery?
Ascites, an accumulation of fluid in the abdomen, can occur with DSRS surgery. This can be treated with diuretics and by restricting sodium in the diet.
Follow-Up Care Following TIPS or DSRS Procedures
Follow-up care for TIPS and DSRS can differ depending on where the procedures are performed. Below find basic guidelines.
- Ten days after hospital discharge, meet with your surgeon or hepatologist (liver specialist) to evaluate your progress. Lab work will be done at this time.
- Six weeks after the TIPS procedure (and again three months after the procedure), have an ultrasound so your doctor can check that the shunt is functioning properly. You will have an angiogram (an X-ray of blood vessels) only if the ultrasound indicates that there is a problem. You will also have lab work done at these times.
- Six weeks after the DSRS procedure (and again three months after the procedure), meet with the surgeon to evaluate your progress. Lab work will be done at these times.
- Six months after either the TIPS or DSRS procedure, have an ultrasound to make sure the shunt is working properly. Also, visit the surgeon or hepatologist.
- Twelve months after either procedure, have another ultrasound of the shunt. Also, you may have an angiogram so that your doctor can check the pressure within the veins across the shunt.
- If the shunt is working well, every six months after the first year of follow-up appointments, have an ultrasound, lab work, and visit with your doctor.
- More frequent follow-up visits may be necessary, depending on your condition.
Attend all follow-up appointments as scheduled to ensure that the shunt is functioning properly. Be sure to follow the dietary recommendations that your health care providers give you.