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Liver Procedures
Transjugular Intrahepatic Portosystemic Shunt (TIPS)
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Transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive procedure used to reduce high blood pressure within the veins supplying the liver (portal hypertension), most commonly caused by liver cirrhosis.

 

Using imaging guidance, a stent is inserted through the liver to create a channel between the portal and hepatic veins, allowing blood to bypass the increased resistance of the diseased liver. TIPS is used to treat serious complications of portal hypertension, including abdominal fluid accumulation (ascites) and life-threatening bleeding from enlarged veins (varices) in the oesophagus or stomach.

TIPS is not appropriate for individuals with hepatic encephalopathy and certain heart conditions. As such, a gastroenterologist referral is mandatory.

 

Benefits include:

  • Effective reduction of portal hypertension

  • Prevention or control of acute or recurrent variceal bleeding

  • Reduction in refractory ascites and abdominal distension

  • Reduced need for repeated abdominal fluid drainage (paracentesis)

  • Improvement in selected cases of hepatic hydrothorax

  • Potential improvement in quality of life and survival in appropriately selected patients

  • Minimally invasive treatment without open abdominal surgery

  • May provide a bridge to liver transplantation

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Balloon-occluded retrograde transvenous obliteration (BRTO) 

Balloon-occluded retrograde transvenous obliteration (BRTO) is a minimally invasive procedure used to treat enlarged gastric veins (varices) caused by portal hypertension, most commonly associated with liver cirrhosis.

 

These abnormal veins can cause serious or life-threatening gastrointestinal bleeding. BRTO prevents or treats recurrent bleeding, and may also improve hepatic encephalopathy (confusion and altered mental function) caused by abnormal blood flow bypassing the liver. Careful patient selection is essential, as BRTO can increase portal pressure and worsen complications such as ascites or oesophageal varices.

 

Using imaging guidance, a catheter is inserted through a vein in the groin or neck and advanced into the abnormal veins, which are then blocked using a balloon and injected with a sclerosing agent to permanently close them. 

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Benefits include:

  • Effective treatment of bleeding gastric varices, with reduced risk of recurrent bleeding

  • Potential improvement in hepatic encephalopathy

  • Preservation or improvement of blood flow through the liver

  • Alternative to TIPS in patients at increased risk of complications

  • Minimally invasive treatment without open abdominal surgery

Portal Vein Embolisation
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Portal vein embolisation (PVE) is a minimally invasive procedure performed before major liver surgery to encourage growth of the healthy liver that will remain after surgery. It is commonly used in patients requiring resection of a large portion of the liver to remove cancer.

Using imaging guidance, a catheter is inserted through the skin into the portal venous system, and small particles, coils or medical glue are used to block blood flow to the portion of the liver planned for surgical removal. This stimulates the remaining healthy liver to grow over the following weeks. By increasing the volume of the remaining liver, PVE reduces the risk of liver failure following the cancer  resection.
 

Benefits include:

  • Stimulates growth of the healthy liver before cancer resection surgery

  • Reduces the risk of postoperative liver failure

  • May enable major liver surgery that would otherwise be considered unsafe

  • Minimally invasive day procedure without open surgery

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