About Transjugular Intrahepatic Portosystemic Shunt

A transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive procedure to connect two veins in the liver. This procedure is typically performed on patients with portal hypertension, or increased pressure in the portal vein system. A buildup of pressure in this area can cause blood to flow back from the liver into veins in the stomach, lower esophagus, and intestines.

TIPS connects the portal vein to the hepatic vein in the liver, utilizing a stent to keep the connection open. This reroutes blood draining from the bowel to return to the heart while avoiding the liver, preventing any backflow of blood and reducing high blood pressure in the portal vein.

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Carotid Artery Disease

Carotid artery disease is a common condition with more than 200,000 new cases reported in the US each year. This disease occurs when plaque builds up inside the carotid arteries that supply oxygen-rich blood to the brain, face, scalp, and neck. This plaque buildup causes the arteries to become stiff and narrow, making it difficult for the blood to flow normally. On some occasions, small clots can form in the artery. If these clots break off and travel to the brain, they can cause a stroke.

According to the Society for Vascular Surgery, carotid artery disease is responsible for up to one-third of all strokes. Approximately 700,000 strokes occur each year, usually in men.

Carotid artery disease develops slowly, making it more common in older individuals. It’s estimated that up to 3% of people aged 65 and older have carotid artery disease. The following factors can put you more at risk of developing this condition:

  • Smoker or history of smoking
  • High blood pressure or hypertension
  • High cholesterol
  • Diabetes
  • Heart disease
  • Family history of atherosclerosis (plaque buildup)
  • Lack of physical activity
  • Overweight


In many cases, there aren’t any signs or symptoms in the early stages of this disease. Often, it will go undetected until severe narrowing or blockage of the artery occurs, causing a transient ischemic attack (TIA), which is a brief stroke-like episode, or stroke. Common symptoms of a TIA or stroke include:

  • Sudden, severe headache
  • Numbness or weakness in the face or limbs, often only affecting one side of the body
  • Difficulty speaking or understanding speech
  • Dizziness or loss of balance
  • Vision problems in one or both eyes


The physicians at Vascular & Vein Institute of Siouxland use your medical history, a physical exam, and diagnostic tests to diagnose carotid artery disease.

Medical History

Your physician will determine whether you have any of the major risk factors for carotid artery disease or if you have experienced any TIA or stroke symptoms.

Physical Exam

During a physical exam, your physician will listen to your carotid arteries with a stethoscope. They will be listening for a bruit, or whooshing sound, which can indicate reduced blood flow. It is important to note that not every person with carotid artery disease will have a bruit.

Diagnostic Tests

The physicians at Vascular & Vein Institute of Siouxland primarily use an ultrasound or angiogram to help diagnose this condition. Ultrasounds are the most common way to diagnose narrowing or blockage in the arteries. This test uses sound waves to produce images and is completely painless.

If the ultrasound results are unclear, your physician may choose to use an angiogram. During an angiogram, your physician threads the catheter to the area of interest and releases a small amount of contrast from the catheter. The contrast allows the blood vessels to appear on the x-ray.


Treating carotid artery disease often involves a combination of lifestyle changes, medication, and, in severe cases, surgery.

Lifestyle Changes

Common lifestyle changes that could be recommended by your physician include:

  • Quitting smoking
  • Increasing physical activity
  • Diet changes


When used properly, a combination of medications can help to slow the progression of this disease. Often, aspirin is prescribed along with medications to help lower cholesterol and blood pressure. Medication is usually prescribed when the degree of narrowing is less than 60%.


Surgery is most commonly recommended when the degree of narrowing exceeds 60%. When necessary, the physicians at Vascular & Vein Institute of Siouxland can perform an angioplasty, a procedure to help widen the arteries.

During this procedure, a catheter with an inflatable balloon is threaded to the area of narrowing or blockage. Once in position, the balloon is inflated, expanding the artery and compacting the blockage. The physician will then deflate and remove the balloon before injecting contrast to ensure the procedure was successful.

Stents can also be used during an angioplasty. They are a permanent implant and are often used following a balloon angioplasty if there is still insufficient blood flow.

Call (605) 217-5617 to schedule an appointment with one of our physicians.