Non-surgical treatment of high portal vein pressure,variceal bleeding and  ascites (TIPS,BRTO)

Transjugular intrahepatic portosystemic shunt (TIPS)

Balloon-occluded retrograde transvenous obliteration (BRTO)

What is a TIPS procedure?

TIPS is a procedure that involves the placement of a stent-like device that connects the portal vein to a hepatic vein in the liver. This creates a new pathway for blood to flow, bypassing the liver and reducing the pressure in the portal vein.

Why is a TIPS procedure performed?

TIPS is usually performed to treat complications of portal hypertension, such as variceal bleeding, ascites, and hepatic encephalopathy. It may also be used as a bridge to liver transplantation in patients with end-stage liver disease.

How is a TIPS procedure performed?

A TIPS procedure is performed under local anesthesia and conscious sedation. A small incision is made in the jugular vein in the neck, and a catheter is inserted through the incision and guided to the liver. Once in place, a stent-like device is inserted to connect the portal vein to a hepatic vein.

Is a TIPS procedure painful?

The procedure itself is not painful, as it is performed under local anesthesia and conscious sedation. However, patients may experience some discomfort at the site of the incision and may feel some pressure during the procedure.

What are the risks of a TIPS procedure?

Like any medical procedure, TIPS carries some risks. The most common complications include bleeding, infection, and narrowing or blockage of the shunt. Other less common but more serious complications include liver failure, cardiac complications, and encephalopathy.

How long does a TIPS procedure take?

The procedure usually takes between 1 and 2 hours to perform.

How long does it take to recover from a TIPS procedure?

Most patients are able to go home the day after the procedure. Recovery time can vary depending on the individual patient and the reason for the TIPS procedure, but most patients can return to normal activities within a few days to a week after the procedure.

What are the long-term effects of a TIPS procedure?

Long-term effects of a TIPS procedure can include the development of new varices or shunt dysfunction. Regular follow-up appointments with a healthcare provider are important to monitor for any potential complications.

Will I need to take medication after a TIPS procedure?

Patients may need to take medications to prevent blood clots or to manage complications of portal hypertension after a TIPS procedure. The specific medications prescribed will depend on the individual patient and their medical history.

Will I need to change my diet after a TIPS procedure?

Most patients do not need to make significant dietary changes after a TIPS procedure, but it is important to follow a healthy, balanced diet to support liver function and overall health. Patients with ascites may need to follow a low-sodium diet to help manage fluid retention. It is important to discuss any dietary concerns with a healthcare provider.

How effective is TIPS at treating complications of portal hypertension?

TIPS has been shown to be highly effective at reducing portal hypertension and improving the symptoms associated with complications such as variceal bleeding, ascites, and hepatic encephalopathy. However, the success of the procedure can depend on various factors, including the underlying cause of the portal hypertension, the patient's overall health, and the experience of the medical team performing the procedure.

What should I expect during a TIPS follow-up appointment?

During a TIPS follow-up appointment, your healthcare provider will likely perform a physical exam and review your medical history to monitor for any potential complications. You may also undergo imaging tests, such as an ultrasound or CT scan, to evaluate the function of the shunt. It is important to attend all scheduled follow-up appointments to ensure that any potential issues are detected and treated early.

Can TIPS be reversed if necessary?

In some cases, TIPS can be reversed if necessary. However, the decision to reverse the procedure will depend on various factors, including the reason for the original TIPS procedure, the patient's overall health, and the potential risks and benefits of reversal. If you are considering a TIPS procedure, it is important to discuss the potential risks and benefits with your healthcare provider.

What are the alternatives to TIPS for treating complications of portal hypertension?

There are several alternative treatments for complications of portal hypertension, including medication therapy, endoscopic therapy (such as banding or sclerotherapy), and surgical shunts. The choice of treatment will depend on various factors, including the underlying cause of the portal hypertension, the patient's overall health, and the severity of the symptoms.

What can I do to prepare for a TIPS procedure?

Before a TIPS procedure, you may be instructed to fast for several hours, and you may need to stop taking certain medications. It is important to follow all pre-procedure instructions provided by your healthcare provider. You should also arrange for someone to drive you home after the procedure, as you may still be feeling the effects of sedation.

How can I manage my symptoms after a TIPS procedure?

After a TIPS procedure, you may experience some mild discomfort or pain at the site of the incision. Your healthcare provider may prescribe pain medication or recommend over-the-counter pain relievers to manage these symptoms. It is also important to rest and avoid strenuous activity for several days after the procedure. If you experience any unusual symptoms, such as fever, severe pain, or bleeding, it is important to contact your healthcare provider right away.

Are there any lifestyle changes I should make after a TIPS procedure?

In general, it is important to maintain a healthy lifestyle after a TIPS procedure to support liver function and overall health. This may include following a balanced diet, getting regular exercise, and avoiding alcohol and tobacco. If you have any specific concerns about lifestyle changes after a TIPS procedure, it is important to discuss them with your healthcare provider.

What should I do if I experience complications after a TIPS procedure?

If you experience any unusual symptoms after a TIPS procedure, such as fever, severe pain, or bleeding, it is important to contact your healthcare provider right away. Early detection and treatment of complications can help prevent more serious issues from developing.

What is the long-term outlook after a TIPS procedure?

The long-term outlook after a TIPS procedure can vary depending on various factors, including the underlying cause of the portal hypertension, the patient's overall health, and the success of the procedure. Some patients may experience long-term benefits from TIPS, while others may require additional treatments or interventions. Regular follow-up appointments with a healthcare provider are important to monitor for any potential complications and to adjust treatment as needed.

What is Balloon-occluded retrograde transvenous obliteration (BRTO) ?

BRTO is a procedure that involves using a catheter to insert a balloon into a vein in the groin and threading it through the veins to reach the varices. The balloon is then inflated to block the blood flow to the varices. This causes the varices to shrink and eventually disappear, reducing the risk of bleeding and other complications.

Why is BRTO done?

BRTO is primarily used to treat varices in the liver that are causing bleeding or are at high risk of bleeding. This can occur in patients with liver cirrhosis, which is a condition where the liver is damaged and scarred, often due to alcohol abuse or viral hepatitis. Varices can also develop in patients with other liver diseases, such as Budd-Chiari syndrome or portal vein thrombosis.

How is BRTO performed?

BRTO is performed under local anesthesia and conscious sedation, meaning that the patient is awake but relaxed during the procedure. A small incision is made in the groin, and a catheter is inserted into a vein in the leg. The catheter is then threaded through the veins to reach the varices. Once the catheter is in place, a balloon is inflated to block the blood flow to the varices. A special medication is then injected into the varices to make them shrink and disappear.

What are the risks and complications of BRTO?

Like any medical procedure, BRTO carries some risks and potential complications. These can include bleeding, infection, allergic reactions to medications used during the procedure, damage to surrounding organs or tissues, and blood clots. However, serious complications are rare, and most patients experience only minor discomfort or temporary side effects.

What is the recovery like after BRTO?

After the procedure, patients are typically monitored in the hospital overnight to ensure that there are no complications. Most patients are able to go home the next day and can resume normal activities within a few days. Patients may experience some mild discomfort or soreness in the groin area for a few days after the procedure, but this usually goes away on its own.

How effective is BRTO?

BRTO has been shown to be highly effective in treating varices in the liver. Studies have found that the procedure can significantly reduce the risk of bleeding and other complications in patients with liver cirrhosis and other liver diseases. However, the long-term effectiveness of the procedure may vary depending on the underlying condition and other factors, and some patients may require repeat treatments in the future.

Who is a good candidate for BRTO?

BRTO may be recommended for patients with varices in the liver who are at high risk of bleeding or who have already experienced bleeding. It may also be recommended for patients who are not candidates for other types of treatment, such as surgery or transjugular intrahepatic portosystemic shunt (TIPS). The decision to undergo BRTO will depend on the patient's individual medical history and the severity of their condition.

Are there any alternatives to BRTO for treating varices in the liver?

Yes, there are several alternative treatments for varices in the liver, depending on the severity of the condition and the underlying cause. These may include:

Medications: Drugs such as beta-blockers or nitrates can be used to reduce the pressure in the blood vessels and prevent bleeding.

Endoscopic therapy: Endoscopic procedures, such as banding or sclerotherapy, can be used to directly treat the varices and reduce the risk of bleeding.

TIPS: Transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive procedure that involves placing a stent-like device in the liver to redirect blood flow and reduce pressure in the varices.

Surgical shunts: In some cases, surgery may be required to create a shunt (a bypass) between the liver and another blood vessel to reduce pressure in the varices.

The choice of treatment will depend on the individual patient's medical history and the severity of their condition. A doctor will work with the patient to determine the best course of action.

Is BRTO painful?

BRTO is typically not painful because it is performed under local anesthesia and conscious sedation, which helps to keep the patient relaxed and comfortable during the procedure. However, patients may experience some mild discomfort or soreness in the groin area for a few days after the procedure.

How long does BRTO take?

The procedure typically takes about 1-2 hours to complete, although this can vary depending on the complexity of the case and other factors. Patients will need to stay in the hospital for at least one night after the procedure for observation.

How long does it take for the varices to shrink after BRTO?

The varices will begin to shrink immediately after the procedure, but it may take several weeks or months for them to completely disappear. During this time, patients may need to undergo regular follow-up tests to monitor the progress of the treatment and ensure that the varices have been effectively treated.

Can BRTO be performed on an outpatient basis?

BRTO is typically performed on an inpatient basis, meaning that the patient will need to stay in the hospital overnight for observation. However, in some cases, the procedure may be performed on an outpatient basis if the patient meets certain criteria, such as having a stable medical condition and a low risk of complications.