Question

You detect abnormal hepatofugal flow in the portal vein and suspect that your patient has portal hypertension and that the radiologist may consider doing a transjugular intrahepatic portal-systemic shunt (TIPSS). What flow changes would you expect to see if the TIPSS procedure is successful?

a) The pressure in the portal vein would decrease and flow would be hepatopetal.
b) Blood would be shunted from the portal vein into the superior mesenteric vein.
c) Decrease flow in the hepatic vein would be evident.
d) The pressure in the hepatic vein would decrease.

Answer 1

After successful TIPS, portal vein pressure decreases, and blood flow becomes hepatopetal. The hepatic vein flow increases as it receives shunted blood from the portal vein system.

Step-by-step explanation:

If a transjugular intrahepatic portal-systemic shunt (TIPS) procedure is successful, you would expect to see a decrease in pressure within the portal vein due to the shunting of blood to the systemic circulation, which lessens the burden on the portal venous system. As a result, the flow in the portal vein would revert to its normal direction, which is hepatopetal towards the liver. The TIPS acts by creating a pathway between the hepatic vein and portal vein, allowing blood to flow from the high-pressure portal vein system to the lower-pressure systemic venous system, which includes the hepatic vein.

The TIPSS procedure does not cause a blood shunt from the portal vein into the superior mesenteric vein; instead, it shunts blood from the portal venous system into the systemic circulation through the hepatic vein. Thus, blood flow in the hepatic vein would actually increase due to the additional volume coming from the portal system. Since the procedure reduces portal hypertension, there would not be a significant change in pressure in the hepatic vein; the extra volume from the shunt would flow through it into the inferior vena cava.