Portal Vein Procedures for Portal Hypertension

People with portal hypertension may benefit from advanced portal vein procedures, including TIPS, DIPS, BRTO/CRTO and variceal occlusion.

Portal hypertension is higher than normal pressure in some of the veins within the abdomen, a condition that may result from a liver disease such as cirrhosis. When left untreated, portal hypertension can result in more serious health risks. People with portal hypertension may present with massive bleeding from varicose veins in the esophagus, or with fluid accumulation in the abdomen (ascites).

Treatment for portal hypertension

First-line treatments for portal hypertension include:

• Endoscopic therapy to block off the varices (abnormally enlarged blood vessels) in the esophagus
• Medications

Advanced treatment for portal hypertension

For people with portal hypertension who have failed to respond to these treatments, Henry Ford Interventional Radiology offers advanced liver interventions, including several portal vein procedures:

• Transjugular intrahepatic portosystemic shunt (TIPS) procedure
• Direct intrahepatic portocaval shunt (DIPS) procedure
• A group of portal vein procedures with the common goal of directly blocking varices. This includes CARTO (coil-assisted retrograde transvenous obliteration), BRTO (balloon-assisted retrograde transvenous obliteration) and variceal occlusion.

The TIPS procedure

In this portal vein procedure:

• A stent (metal mesh tube) is used to reroute blood flow through the liver.
• This stent creates a new path between the portal vein (which carries blood from the intestines to the liver) and the hepatic veins (which carry blood from the liver to the heart).
• For patients who have narrow or blocked hepatic veins, Henry Ford Interventional Radiology offers an alternative treatment, the DIPS procedure.

During the TIPS procedure

These procedures are typically performed under general anesthesia. During the TIPS procedure, your Henry Ford interventional radiologist will:

• Administer a local anesthetic at the insertion site.
• Place a catheter into the hepatic veins, measure pressures to confirm the diagnosis and obtain diagnostic X-ray images.
• Insert a special needle through the liver to reach the portal vein inside the liver and begin the process of establishing the artificial connection.
• Using X-ray guidance, place the stent into a vein in your liver and then connect your portal vein with a hepatic vein.
• Remove the catheter.

After the TIPS procedure

• You are closely monitored for bleeding while you recover and the effects of any medications you were given begin to wear off.
• Most people are able to resume normal activities about a week after the procedure.
• We may order an ultrasound after the procedure and then again a few weeks later to ensure the stent is working correctly.

The DIPS procedure

If you are not a candidate for TIPS, or a TIPS procedure was unsuccessfully attempted elsewhere, a DIPS procedure may be another option for you. This portal vein procedure:

• Is very similar to a TIPS procedure, except that the stent runs from the main abdominal vein (inferior vena cava, or IVC) to the portal vein directly
• Is a very specialized procedure, which requires use of a special intravascular (inside the blood vessel) ultrasound imaging probe

CARTO, BRTO and variceal occlusion

This is a highly specialized group of procedures with the common goal of directly blocking abnormally enlarged blood vessels (varices), which are a frequent cause of bleeding in patients with liver disease and portal hypertension.

• CARTO/BRTO may be offered for people who are not candidates for a TIPS procedure, or where physicians feel the CARTO/BRTO approach may be better for the patient.
• This type of procedure was popularized in Southeast Asia and is becoming increasingly utilized in North America.
• Henry Ford interventional radiologists are skilled in all forms of portal vein intervention, including variceal occlusion.