Complex Transjugular Intrahepatic Portosystemic Shunt (TIPS) Cost in India

Transjugular Intrahepatic Portosystemic Shunt (TIPS) Interventional (Complex) is an advanced medical procedure designed to address complex complications associated with portal hypertension, typically stemming from liver cirrhosis. This sophisticated intervention involves the creation of a shunt within the liver to redirect blood flow, reducing pressure in the portal vein. TIPS Interventional (Complex) is often employed when standard TIPS procedures may not suffice due to challenging anatomical considerations, prior interventions, or specific patient conditions. It requires specialized expertise and advanced imaging techniques to navigate intricacies, providing an essential tool for managing intricate cases of portal hypertension and its associated complications.

Why Do You Need TIPS Interventional (Complex)?

The need for Transjugular Intrahepatic Portosystemic Shunt (TIPS) Interventional (Complex) arises in cases where standard TIPS procedures may not be sufficient due to intricate anatomical considerations, prior interventions, or specific patient conditions. Here are key reasons why TIPS Interventional (Complex) may be required:

• Challenging Anatomy: In some patients, complex vascular anatomy or variations in blood vessel structures may make the standard TIPS procedure challenging. Complex TIPS procedures are designed to navigate and address such intricacies.
• Previous Interventions: Patients who have undergone previous abdominal surgeries, liver interventions or have existing shunts may present complex anatomical challenges. TIPS Interventional (Complex) is tailored to manage such scenarios effectively.
• Recurrence of Complications: The complex variant may offer a more tailored solution to address ongoing issues for individuals with a recurrence of complications such as variceal bleeding or refractory ascites after standard TIPS.
• Individualized Patient Conditions: Certain patient conditions, such as unique variations in blood vessel anatomy or comorbidities, may necessitate a more intricate approach to achieve successful portal decompression.
• Enhanced Expertise: TIPS Interventional (Complex) requires specialized expertise in interventional radiology to navigate and overcome complex anatomical challenges. Interventional radiologists with advanced skills are essential for the success of these procedures.
• Tailored Approach: TIPS Interventional (Complex) 's complex nature allows for a more individualized and tailored approach, ensuring that the procedure is optimized to address the specific challenges presented by the patient's anatomy and clinical history

Types of TIPS Interventional (Complex)

Transjugular Intrahepatic Portosystemic Shunt (TIPS) Interventional (Complex) procedures encompass various types adapted to address intricate anatomical challenges and patient-specific conditions. Some types include:

• Retrograde TIPS: In cases where traditional antegrade approaches face difficulties, retrograde TIPS involves accessing the portal vein in a reverse direction. This approach may be utilized when there are challenges in navigating the catheter antegradely.
• Parallel TIPS: This involves creating multiple shunts within the liver to further enhance portal decompression. It is employed when a single shunt may not provide sufficient relief, and additional pathways are needed.
• BRTO-TIPS Combination: Combining Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) with TIPS, this approach addresses both portal hypertension and gastric varices simultaneously.
• Direct Intrahepatic Portocaval Shunt (DIPS): DIPS involves creating a direct shunt between the portal vein and the inferior vena cava without traversing liver tissue. This may be considered in specific cases where other approaches are challenging.
• Covered Stent TIPS: Covered stents may be necessary to address specific complications, such as preventing stent-related bleeding or managing hepatic encephalopathy.
• Transsplenic Approach: In challenging cases, accessing the portal vein through the splenic vein may be considered, providing an alternative route for shunt creation.
• Chemoembolization-Assisted TIPS: This involves combining TIPS with chemoembolization techniques, often used in cases of hepatocellular carcinoma complicating portal hypertension.-

How Patients are Selected for the Procedure? 

The selection of patients for Transjugular Intrahepatic Portosystemic Shunt (TIPS) Interventional (Complex) involves a meticulous assessment by a multidisciplinary team, including hepatologists, interventional radiologists, and other specialists. Key considerations for patient selection include:

• Complex Anatomical Challenges: Patients with complex vascular anatomy, variations in blood vessel structures, or challenging access routes may be considered for TIPS Interventional (Complex). This procedure is designed to navigate and address such intricacies.
• Prior Interventions or Surgeries: Individuals with a history of previous abdominal surgeries, liver interventions, or existing shunts that may complicate the standard TIPS procedure may be candidates for the complex variant.
• Recurrent Complications: Patients experiencing a recurrence of complications such as variceal bleeding or refractory ascites despite standard TIPS may be considered for the complex procedure to address ongoing issues.
• Comprehensive Medical Assessment: The patient's overall health status is thoroughly evaluated, including liver function, coagulation profile, and any comorbidities that may impact the procedure's safety and efficacy.
• Advanced Imaging Studies: Advanced imaging techniques, such as CT scans, MRI, or angiography, are employed to assess the patient's vascular anatomy and liver condition and identify any challenges that may necessitate a complex approach.
• Patient Goals and Preferences: Shared decision-making involves discussing the potential benefits and risks of TIPS Interventional (Complex) with the patient, considering their treatment goals and preferences, and understanding their commitment to post-procedural care.

Diagnostic Tests and Evaluations Performed to Determine the Need for TIPS Interventional (Complex)

Diagnostic tests and evaluations are crucial in determining the need for Transjugular Intrahepatic Portosystemic Shunt (TIPS) Interventional (Complex), ensuring the procedure is tailored to the patient's specific conditions. Key assessments include:

• Advanced Imaging Studies: High-resolution imaging techniques, such as CT scans, MRI, or angiography, provide detailed insights into the patient's liver anatomy, vascular structures, and any abnormalities that may complicate standard TIPS procedures.
• Doppler Ultrasound: Doppler ultrasound is utilized to assess blood flow dynamics, identify the severity of portal hypertension, and evaluate the suitability of the vessels for the TIPS Interventional (Complex) procedure.
• Angiography: This invasive imaging technique involves injecting contrast dye into blood vessels to visualize the hepatic and portal veins. This aids in assessing blood flow patterns and identifying any abnormalities that may impact the procedure.
• Hepatic Venous Pressure Gradient (HVPG) Measurement: HVPG measurement provides direct information on portal hypertension severity. Elevated HVPG values may indicate a higher risk of complications and influence the decision to opt for TIPS Interventional (Complex).
• Liver Function Tests: Comprehensive liver function tests, including assessments of liver enzymes, bilirubin, and albumin levels, are conducted to evaluate the overall liver health and assess the impact of portal hypertension on hepatic function.
• Coagulation Profile: Assessing the patient's coagulation profile, including prothrombin time (PT) and international normalized ratio (INR), is essential to gauge bleeding risk during and after the procedure.
• Medical History and Clinical Evaluation: A thorough review of the patient's medical history, symptoms, and physical examination helps understand the overall health status, identify any contraindications, and tailor the TIPS Interventional (Complex) approach accordingly.