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Current diagnosis and management of post‐transjugular intrahepatic portosystemic shunt refractory hepatic encephalopathy |
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| Authors: | Keith Pereira Andres F. Carrion Paul Martin Kirubahara Vaheesan Jason Salsamendi Mehul Doshi Jose M. Yrizarry |
| Affiliation: | 1. Department of Interventional Radiology, Jackson Memorial Hospital, University of Miami Hospital, Miami, FL, USA;2. Division of Hepatology, Jackson Memorial Hospital, University of Miami Hospital, Miami, FL, USA;3. Department of Interventional Radiology, Saint Louis University School of medicine, St Louis, MO, USA |
| Abstract: | Transjugular intrahepatic portosystemic shunt has evolved into an important option for management of complications of portal hypertension. The use of polytetrafluoroethylene covered stents enhances shunt patency. Hepatic encephalopathy (HE) remains a significant problem after TIPS placement. The approach to management of patients with refractory hepatic encephalopathy typically requires collaboration between different specialties. Patient selection for TIPS requires careful evaluation of risk factors for HE. TIPS procedure‐related technical factors like stent size, attention to portosystemic pressure gradient reduction and use of adjunctive variceal embolization maybe important. Conservative medical therapy in combination with endovascular therapies often results in resolution or substantial reduction of symptoms. Liver transplantation is, however, the ultimate treatment. |
| Keywords: | hepatic encephalopathy portal hypertension spontaneous portosystemic shunt transjugular intrahepatic portosystemic shunt |