TIPS for blood clots: how it works, risks, and recovery

TL;DR:

• TIPS creates a new channel inside the liver to lower portal pressure.
  
• It can help when a blood clot blocks the portal vein or varices bleed.
  
• Interventional radiologists place a stent through a neck vein under imaging.
  
• Main risks are hepatic encephalopathy and shunt narrowing or blockage.
  
• Most people go home in 1 to 2 days with scheduled ultrasound checks.
  

What is the TIPS procedure?

TIPS stands for transjugular intrahepatic portosystemic shunt. It is a minimally invasive procedure that connects the portal vein to a hepatic vein using a stent. This new channel lowers high pressure in the portal system. RadiologyInfo and Cleveland Clinic explain that doctors use x-ray and ultrasound during the procedure, entering through a neck vein.

Why TIPS is used for “blood clots”

Here, “blood clots” usually means a clot in the portal vein, called portal vein thrombosis. In people with cirrhosis, portal vein clots and scarred liver tissue raise portal pressure. That pressure can cause varices, bleeding, and fluid buildup. A TIPS can reduce pressure and, in many cases, help reopen the vein when paired with portal vein recanalization techniques, often called PVR-TIPS. Reviews and guidance describe PVR-TIPS as effective for restoring flow, especially in liver transplant candidates.

Other reasons doctors consider TIPS

Doctors also use TIPS to control variceal bleeding that does not stop with endoscopy, and to treat refractory ascites. AASLD guidance supports early or preemptive TIPS in selected high-risk bleeding cases.

Who might be a candidate

You may be considered for TIPS if you have any of the following:

• Portal vein thrombosis with symptoms or risk of complications.
  
• Recurrent or uncontrolled variceal bleeding despite endoscopic care.
  
• Refractory ascites that persists despite diuretics and salt restriction.
  

Eligibility depends on liver function, heart and kidney health, and clot extent. Your care team will review imaging, labs, and prior treatments before deciding. Guidance documents outline patient selection and preprocedure evaluation.

Who should avoid TIPS

TIPS is not advised if you have severe liver failure, uncontrolled infection, severe heart failure, very high pulmonary pressures, or unrelieved bile duct blockage. Older reviews and patient guides list these as common contraindications. Your team weighs risks and benefits for your case.

How the procedure works, step by step

1. You receive sedation or general anesthesia.
   
2. The doctor advances a thin tube through the right internal jugular vein to the liver.
   
3. Using ultrasound and x-ray, the doctor passes a needle from a hepatic vein into the portal vein.
   
4. The tract is widened with a balloon.
   
5. A metal stent or covered stent-graft is placed to keep the channel open.
   
6. Pressures are measured, then the access site in the neck is closed.
   

For portal vein clots, the team may first recanalize the portal vein from the liver side or using a combined approach, then place the TIPS.
How long it takes and hospital stay

Most procedures take 1 to 3 hours. Many patients stay one night. Some need longer if bleeding was severe or if other conditions must be stabilized. Patient education pages from large centers report similar timelines.

Benefits you can expect

• Lower portal pressure and reduced risk of variceal bleeding.
  
• In selected cases, restored flow through a previously blocked portal vein.
  
• Less fluid buildup in the abdomen when ascites is the problem.
  

Studies of PVR-TIPS show high technical success and good patency when used for portal vein thrombosis in cirrhosis, including in people preparing for transplant.

Risks and side effects

All procedures have risks. Common or important risks of TIPS include:

• Hepatic encephalopathy. Lowering portal pressure can increase toxin exposure to the brain. Diet, medicines, and follow-up limit this risk.
  
• Shunt stenosis or thrombosis. The stent can narrow or clot. This is tracked with imaging and treated with ballooning or revision.
  
• Bleeding, infection, or injury to nearby structures. These are less common in expert centers.
  
• Heart strain or liver failure in high-risk patients. Careful selection helps prevent this.
  

Complications and their management are well described in interventional radiology references and guidelines.

Preparing for your TIPS

Your team will:

• Review medications and manage any blood thinners.
  
• Treat active infections first.
  
• Check heart and lung function if needed.
  
• Confirm anatomy with ultrasound or CT.
  

You will fast for several hours before the procedure and arrange a ride home. Written patient guides from hospitals and RadiologyInfo cover these steps.

Recovery and follow-up

Expect a small bandage on the neck. Mild soreness is common. You will get instructions on diet, activity, and signs to watch. Most people resume light activity in one week. Ultrasound checks are typically scheduled at 1 to 2 weeks, then at 3 months, 6 months, and every 6 to 12 months to confirm stent flow. Centers may adjust timing based on your situation.

Alternatives to TIPS for portal vein clots

• Anticoagulation to help the body dissolve the clot when safe.
  
• Catheter-directed thrombolysis or thrombectomy in selected cases.
  
• Endoscopic therapy for varices if bleeding is the main issue.
  
• Surgical shunts in centers with expertise when TIPS is not possible.
  

Your hepatology and interventional radiology teams will tailor the plan to your goals, clot location, and liver function. Guidance documents compare these paths.

Quick checklist for your appointment

When to seek urgent help

Call your care team or emergency services for heavy bleeding, new severe belly pain, confusion, fever, chest pain, or shortness of breath. These need quick review after a TIPS.

Why it matters

Portal vein thrombosis can be life threatening. It can block blood flow to the liver and raise portal pressure. TIPS, often paired with portal vein recanalization, gives doctors a way to quickly reduce pressure and restore flow in selected patients. Early referral to hepatology and interventional radiology improves outcomes and expands options.

Sources:

• RadiologyInfo, Transjugular Intrahepatic Portosystemic Shunt (TIPS), https://www.radiologyinfo.org/en/info/tips, accessed 2025-10-04
  
• Cleveland Clinic, TIPS Procedure, https://my.clevelandclinic.org/health/procedures/tips-procedure, updated 2025-07-27
  
• Hepatology via AASLD, AASLD Practice Guidance on risk stratification and management of portal hypertension and varices in cirrhosis, https://pmc.ncbi.nlm.nih.gov/articles/PMC12057493/, 2024
  
• Seminars in Interventional Radiology, Portal Vein Recanalization–TIPS review, https://pmc.ncbi.nlm.nih.gov/articles/PMC10159708/, 2023
  
• Insights into Imaging, “Bottoms-up” portal venous recanalization TIPS technique review, https://pmc.ncbi.nlm.nih.gov/articles/PMC11663826/, 2024