What Is Portal Hypertension?
Other Treatment Options for Portal Hypertension
If endoscopic therapy, drug therapy, and/or dietary changes don't successfully control variceal bleeding, you may require one of the following procedures to reduce the pressure in these veins. Decompression procedures include:
Transjugular intrahepatic portosystemic shunt (TIPS): This procedure involves placing a stent (a tubular device) in the middle of the liver. The stent connects the hepatic vein with the portal vein, which reroutes blood flow in the liver and helps relieve pressure in abnormal veins.
Distal splenorenal shunt (DSRS): This procedure connects the vein from your spleen to the vein from the left kidney in order to reduce pressure in the varices and control bleeding.
What Tests Are Required Before the TIPS and DSRS Procedures?
Before receiving either of these procedures for portal hypertension, the following tests may be performed to determine the extent and severity of your condition:
- Evaluation of your medical history
- A physical exam
- Blood tests
- Angiogram (an X-ray test that takes pictures of the blood flow within a particular artery)
Before either the TIPS or DSRS procedure, your doctor may ask you to have other tests, which may include an electrocardiogram (EKG) (a test that records the electrical activity of your heart), chest X-ray, or additional blood tests. If your doctor thinks you will need additional blood products (such as plasma), they will be ordered at this time.
What Happens During the TIPS Procedure?
During the TIPS procedure, a radiologist makes a tunnel through the liver with a needle, connecting the portal vein to one of the hepatic veins (veins connected to the liver). A metal stent is placed in this tunnel to keep it open.
The procedure reroutes blood flow in the liver and reduces pressure in all abnormal veins, not only in the stomach and esophagus, but also in the bowel and the liver.
This is not surgery. The radiologist performs the procedure within the vessels under X-ray guidance. The process lasts one to three hours, but you should expect to stay in the hospital overnight after the procedure.