Trans-jugular Intrahepatic PortoSystemic Shunt
aka "TIPSS"

Updated April 5, 2014
Author: Rob Hubbs

Description: Anesthetic Management of Trans-Jugular PortoSystemic Shunts aka "TIPSS" (sometimes called "TIPS") in Interventional Radiology

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Introduction:

A surprisingly good synopsis of the procedure is detailed on the Wikipedia site, found by clicking here .

Management

Preop Considerations

  • Altered mental status from encephalopathy
  • Full stomach considerations due to ascites or GI bleeding
  • Poor drug clearance due to hepatic failure
  • Coexisting diseases: coagulopathy, renal insufficiency, anemia

Physical Findings: Jaundice, ascites, easy bruising, asterixis

Labs:

  • hematocrit, platelet count, INR/PTT, liver function tests, electrolytes (BUN/Cr)
  • Documentation of portal hypertension

 

These patients have liver failure, cirrhosis, and high portal vein pressures resulting in esophageal varices and caput medusa, commonly with ascites.

Most cases are managed with a light endotracheal general anesthetic; sedation is an alternative, but airway obstruction and facial draping can make this approach more difficult.

The operator will get vascular access via the right internal jugular vein.

The procedure can last 4 hours or longer.

References

Review Article 2004 (pdf)