Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation

Surbhi Trivedi; Katie Lam; Ashwin Ganesh; Yasir Hasnain; Wassim Hassan; Josi Herren; Ron C Gaba

doi:10.1055/s-0043-1764282

Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation

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

Authors

Surbhi Trivedi^{1

2}, Katie Lam², Ashwin Ganesh², Yasir Hasnain², Wassim Hassan², Josi Herren^{1

2}, Ron C Gaba^{1

2}

Affiliations

¹ Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Illinois.
² University of Illinois at Chicago College of Medicine, Chicago, Illinois.

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.

Publication types

Review