Last Monday (November 7th) under general anesthetic, I had a procedure to open up the shunt (or stent) that had subsequently clotted off sometime in the late spring of this year. This shunt is called a Transjugular Intrahepatic portosystemic shunt or “TIPS” for short. For further information please view the following short video explanation here: https://cirrhosiscare.ca/tips/
This was the 2nd attempt made to clear the stent, the first one being in late August by Dr. Richard Owen who originally inserted the TIPS in March of 2021. Utilizing the skilled expertise of two interventional radiologists last week (Dr. Rahim Samji and Dr. Richard Owen) at the University of Alberta hospital they managed to push aside the clot into the wall of the stent itself and insert a sleeve to open up blood flow.
As explained to me the procedure was deemed risky, and this after the first attempt to clear the clot back in August. Dr. Owen was unable to move the clot then, so an alternative plan was assembled. After consulting with his colleagues in radiology to determine how to get through the clot it was then decided the best approach was to re-enter through the jugular vein using a micro puncture needle, guidewires, and a microcatheter. Another needle was then directed through the abdomen into the liver in a small window between the gall bladder and right lung.
If blood flow is restricted as it was in my case due to the portal vein of my liver being clotted off, then varices will form. Sometimes these varices will cause major bleeding requiring immediate medical intervention, and in other instances doctors can band them beforehand causing them to slough off to prevent future bleeding episodes. The stent itself guides blood flow around the liver, not through, thus relieving the size and danger level of the surrounding varices. When bypassing the liver in this manor, another risk can take place. Because blood is rerouted around the liver and not through it, hepatic encephalopathy (HE) can sometimes occur. HE is a deterioration in brain function when the liver is compromised by conditions such as portal hypertension.
Prior to entering the OR last week, both doctors explained the method to me before I signed the consent form. Then I was told that there was actually 2 teams in the OR for my procedure and that one team was comprised of technicians from Bayliss Medical . Those technicians were there for the procedure in the event the doctors decided to use RF technology. The machine is called an RF puncture machine . RF technology, is the short version for radio frequency technology. This method has successfully been used in cardiology since 1985 for heart ablation’s of various kinds. The machine can actually can burn through a clot if necessary and might have worked In my case for the clot. As it turns out the method wasn’t used because when they were able to get to the clot, push it to the side of the stent, and insert a sleeve. RF technology for clotting in this region has been only used in only a few cases to date, but that may increase with time.
After all is said and done, I’m still grateful to have survived another medical ordeal. Under observation I stayed in the hospital for 2 nights, and came home on Thursday. Except for some mild tenderness in the liver region, and around the 2 entry points, I feel great for which I am thankful.
I would be remiss if I did not mention my sincere gratitude to the many friends and family who faithfully prayed and extended their kind thoughts prior to the procedure. The peace experienced last Monday before being wheeled into OR was insurmountable and so much so I was giddy about it. I recognize that God heals, and/or preserves our lives but sometimes chooses otherwise. In the case of either outcome, I am okay with that. This I can say now after living with this strange condition just over 20 years now. Never wanting this condition to define me, one just has keep to going. Taking one day at a time, putting one foot in front of the other for as long as the very breath we breathe, is the best objective.
As always your questions or comments or stories are always welcome.
“Gracious words are a honeycomb, sweet to the soul and healing to the bones.” Proverbs 16:24
“But for you who fear My name, the sun of righteousness shall rise with healing in its wings. You shall go out leaping like calves from the stall.” Malachi 4:2
“Peace I leave with you; my peace I give you. I do not give to you as the world gives. Do not be troubled and do not be afraid.” John 14:27
May I ask what your pressure was in the portal vein mine is at 15.2
Sorry I can’t update you just yet as there are plans to go back in in late March to measure the pressure. It will give the doctor an indication of what may be happening since the sleeve was inserted Nov. 7th. I feel good so hopefully nothing has developed again.