Most of the family physicians are aware about coronary angioplasty.Now, I want the family physicians to know about angioplasty procedure (with or without stent) done in gastroenterology practice. Remember that there are very few gastroenterologists and interventional radiologists, who can do this difficult procedure TIPSS. It is done through internal jugular vein, where after putting the catheter in the inferior vena cava, the hepatic vein is reached and obstructions are removed by doing angioplasty and a stent (or any other gadget in case of IVC) is inserted. It may also be put between the biggest vein of the hepatic venous circulation and portal circulation. This procedure could be as costly as a cardiac procedure.

Just as coronary angioplasty with stent may close and need a second intervention, same thing is quite common in TIPSS. In fact, sometimes, instead of opening a blocked/narrow stent, a wide stent is narrowed after the procedure.
The following patients should be sent for consideration for TIPSS:

1. Patients, whose portal hypertension does not respond to i. Medical line of treatment, ii. Procedure like injecting sclerosing solution, or iii. Banding.
2. n a case of haematemesis, where the cause is portal hypertension and the bleeding does not stop with intensive medical treatment, this procedure can be offered to the patient.
3. In anaemia due to congestive gastropathy, which is going to remain lifetime, TIPSS can be offered.
4. Patients having Budd Chiari syndrome are the ideal candidates for this procedure.
5. Finally, patients of resistant ascites, especially those awaiting liver transplant, can be offered this procedure.

Ideally, to achieve good results from this procedure, besides a gastroenterologist, additional help of an interventional radiologist should also be sought at the time of procedure.