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Review
. 2023 May 4;40(1):9-14.
doi: 10.1055/s-0043-1764282. eCollection 2023 Feb.

Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation

Surbhi Trivedi  1   2 , Katie Lam  2 , Ashwin Ganesh  2 , Yasir Hasnain  2 , Wassim Hassan  2 , Josi Herren  1   2 , Ron C Gaba  1   2
Affiliations
Review

Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation

Surbhi Trivedi et al. Semin Intervent Radiol. .

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) creation is effective in treating the sequelae of decompensated liver cirrhosis-including medically refractory ascites and variceal bleeding-by decompressing the portal venous system through a manmade portosystemic conduit within the liver. However, the altered physiology in which splenomesenteric blood bypasses intrahepatic portal venous perfusion can precipitate varying degrees of hepatic encephalopathy (HE). While the majority of post-TIPS HE cases can be treated medically, some require escalated management strategies, including endovascular interventions to modify the indwelling TIPS and/or occlude competitive physiologic spontaneous portosystemic shunts. This review article details the epidemiology, risk factors, diagnosis, classification, and treatment of post-TIPS HE.

Keywords: complication; embolization; hepatic encephalopathy; interventional radiology; transjugular intrahepatic portosystemic shunt.

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Figures

Fig. 1
Fig. 1
A 72-year-old man with primary biliary cirrhosis underwent transjugular intrahepatic portosystemic shunt (TIPS) creation for portal vein stenosis. Digital subtraction portal venogram after TIPS creation ( a ) demonstrated a patent shunt (arrow) and large spontaneous portosystemic shunt (SPSS; arrowhead); portosystemic pressure gradient (PPG) measured 5 mm Hg. Patient subsequently suffered from West Haven grade 3 hepatic encephalopathy (HE), which was refractory to treatment with lactulose and rifaximin; serum ammonia was elevated to 249 μg/dL. Following trans-TIPS SPSS embolization, digital subtraction portal venogram ( b ) showed SPSS occlusion, with PPG increased to 10 mm Hg. HE resolved to West Haven grade 0. Arrow—coils in SPSS.
Fig. 2
Fig. 2
Proposed clinical management algorithm for post-TIPS HE. TIPS, transjugular intrahepatic portosystemic shunt; HE, hepatic encephalopathy; SPSS, spontaneous portosystemic shunt.
See this image and copyright information in PMC

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