Simple Transjugular Intrahepatic Portosystemic Shunt (TIPS) Cost in India

Transjugular Intrahepatic Portosystemic Shunt (TIPS) Interventional (Simple) is a specialized procedure designed to alleviate complications of portal hypertension commonly associated with liver cirrhosis. During this intervention, a shunt is created within the liver to redirect blood flow, reducing pressure in the portal vein. TIPS is employed to manage conditions like variceal bleeding or refractory ascites. The procedure is considered less invasive than surgical alternatives and offers rapid relief. However, careful patient selection and monitoring are essential. TIPS Interventional (Simple) is a valuable tool in managing complex liver-related complications, enhancing patient outcomes and quality of life.

Why Do You Need TIPS Interventional?

The need for Transjugular Intrahepatic Portosystemic Shunt (TIPS) Interventional (Simple) arises in the context of managing complications associated with portal hypertension, often seen in liver cirrhosis. Here are key reasons why TIPS Interventional (Simple) may be recommended:

• Variceal Bleeding: TIPS is often indicated for individuals with variceal bleeding, a serious complication of portal hypertension. TIPS reduces pressure in the portal vein by creating a shunt, minimizing the risk of variceal rupture and subsequent bleeding.
• Refractory Ascites: In cases where ascites (fluid accumulation in the abdominal cavity) are not responsive to medical management, TIPS can improve fluid drainage and alleviate symptoms.
• Hepatorenal Syndrome: TIPS may be considered for patients with hepatorenal syndrome, a severe complication involving kidney dysfunction associated with advanced liver disease.
• Portal Vein Thrombosis: TIPS can be beneficial in certain cases of portal vein thrombosis, helping to manage complications related to impaired blood flow.
• Control of Portal Hypertension: TIPS is designed to reduce portal hypertension, which is elevated blood pressure in the portal vein system. TIPS redirects blood flow by creating a shunt, lowering pressure and mitigating associated complications.
• Prevention of Recurrent Complications: For individuals who have experienced recurrent variceal bleeding or refractory ascites despite other treatments, TIPS can be a valuable intervention to prevent further occurrences.
• Bridge to Liver Transplant: TIPS may serve as a temporary measure for patients awaiting liver transplantation, helping manage complications until a suitable donor organ becomes available.

Types of TIPS Interventional 

Transjugular Intrahepatic Portosystemic Shunt (TIPS) Interventional (Simple) procedures can be categorized based on specific techniques and modifications. Here are common types:

• Bare Metal Stent (BMS) TIPS: This is the standard TIPS procedure in which a bare metal stent is placed to create a shunt within the liver. It helps alleviate portal hypertension by facilitating blood flow diversion.
• Covered Stent TIPS: A covered stent is sometimes used to line the shunt. Its aim is to reduce the incidence of TIPS dysfunction due to tissue ingrowth.
• Parallel TIPS: In certain situations, multiple parallel TIPS can be created to further enhance portal decompression. This technique is employed when a single shunt may not provide sufficient relief.
• Fluoroscopy-Guided TIPS: TIPS procedures are typically guided by fluoroscopy, which involves continuous X-ray imaging for real-time visualization of the catheter and stent placement.
• Ultrasound-Guided TIPS: Some TIPS procedures may use ultrasound guidance and fluoroscopy to enhance precision during catheter placement.
• Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) TIPS: In concurrent issues like gastric varices, BRTO may be combined with TIPS to address portal hypertension and varices.
• Direct Intrahepatic Portocaval Shunt (DIPS): DIPS is a variant of TIPS where the shunt is created directly between the portal vein and the inferior vena cava without traversing the liver tissue.

How Patients are Selected for the Procedure? 

The selection of patients for Transjugular Intrahepatic Portosystemic Shunt (TIPS) Interventional (Simple) involves a comprehensive assessment by a multidisciplinary team, including hepatologists, interventional radiologists, and transplant surgeons. Key considerations for patient selection include:

• Portal Hypertension: TIPS is typically considered for patients with significant portal hypertension, often associated with liver cirrhosis. Elevated portal pressure may lead to complications such as variceal bleeding, refractory ascites, or hepatorenal syndrome.
• Variceal Bleeding: Individuals who have experienced variceal bleeding that is difficult to control with conventional therapies may be candidates for TIPS to reduce the risk of recurrent bleeding.
• Refractory Ascites: TIPS may be considered when ascites fail to respond to medical management. The procedure aims to improve fluid drainage and alleviate symptoms.
• Hepatic Encephalopathy: Patients with a history of hepatic encephalopathy, a complication of liver disease, may still undergo TIPS, but careful consideration is given to the risk of exacerbating encephalopathy.
• Liver Function: Assessing liver function is crucial. TIPS may be contraindicated in cases of severely impaired liver function or decompensated cirrhosis.
• Contraindications: Patients with certain contraindications, such as uncontrolled sepsis, severe heart failure, or significant coagulopathy, may not be suitable candidates for TIPS.
• Assessment of Surgical Risk: For patients deemed high-risk for surgery, TIPS can be a viable alternative, serving as a bridge to liver transplantation in some cases.
• Patient's Goals and Preferences: Shared decision-making involves discussing the procedure's benefits, risks, and potential outcomes with the patient, considering their preferences and treatment goals.

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

Determining the need for Transjugular Intrahepatic Portosystemic Shunt (TIPS) Interventional (Simple) involves a series of diagnostic tests and evaluations to assess the severity of portal hypertension and associated complications. Key assessments include:

• Liver Function Tests: Blood tests measuring liver enzymes, bilirubin, and albumin provide insights into the overall liver function and help assess the severity of liver disease.
• Complete Blood Count (CBC): CBC evaluates platelet count and identifies potential coagulation abnormalities, which are crucial considerations for the procedure.
• Imaging Studies: Imaging modalities such as ultrasound, CT scans, or MRI are employed to visualize the liver and portal vein and assess for varices, ascites, or other complications.
• Endoscopic Evaluation: Upper endoscopy may be performed to identify and grade esophageal varices. This helps determine the risk of variceal bleeding and the need for intervention.
• Hepatic Venous Pressure Gradient (HVPG) Measurement: HVPG measurement provides direct information on portal hypertension severity. A gradient above a certain threshold may indicate a higher risk of complications and the potential need for TIPS.
• Cardiac Evaluation: Assessment of cardiac function is essential, especially in individuals with heart conditions, to ensure their ability to tolerate the hemodynamic changes associated with TIPS.
• Coagulation Profile: The patient's coagulation profile, including prothrombin time (PT) and international normalized ratio (INR), is evaluated to assess bleeding risk during and after the procedure.
• Clinical Evaluation: A thorough clinical evaluation, including medical history, symptoms, and physical examination, helps understand the patient's overall health status and guides the decision-making process.
• Multidisciplinary Consultation: The decision to proceed with TIPS involves collaboration between hepatologists, interventional radiologists, and other specialists to ensure a comprehensive understanding of the patient's condition and suitability for the procedure.