Efficacy of TIPS Reduction for Refractory Hepatic Encephalopathy, Right Heart Failure, and Liver Dysfunction

Unique Method of Transjugular Intrahepatic Portosystemic Shunt Reduction for Refractory Hepatic Encephalopathy

“…In comparison, Schindler et al [16] investigated predominately shunt reduction ( n = 18), reporting that no patients suffered procedural related complications and that there was no significant association between shunt reduction and recurrence of variceal bleeding. Similarly, Sarwar et al [13] reported no recurrence of variceal bleeding following TIPS shunt reduction. Based on the available literature and the author's opinion, TIPS reduction offered a safer treatment option to improve our patient's HE while maintaining patency of the TIPS to prevent recurrent variceal bleeding.…”

“…Shunt reduction methods involve intentionally reducing the diameter of the TIPS lumen, effectively reducing the volume of portal blood flowing through the TIPS while still maintaining shunt patency. Shunt occlusion methods include the use of coil embolization and vascular plugs to fully close the TIPS lumen and eliminate blood flow through the TIPS [10][11][12][13][14][15][16][17]. In a study by Kochar et al [14], 58% of patients who underwent TIPS modification for refractory HE saw an improvement in HE, with similar improvement results between shunt occlusion and shunt reduction.…”

“…In a study by Kochar et al [14], 58% of patients who underwent TIPS modification for refractory HE saw an improvement in HE, with similar improvement results between shunt occlusion and shunt reduction. While both endovascular treatments show effectiveness in treating refractory HE, they are associated with an increased risk of portal hypertension and recurrence of the initial TIPS indication [10][11][12][13][14][15][16]. Safety concerns are more prevalent with shunt occlusion methods, and several life-threatening complications have been noted in the literature [10][11][12][14][15][16].…”

“…In this method, both stents are expanded simultaneously to create a constrained portion in the middle of the existing TIPS lumen, and a resultant example of this method is demonstrated in Figure 4A-4D. Other common methods of TIPS reduction described in the literature include the use of suture-constrained self-expandable stents and tapered reduction stent grafts [13]. TIPS: transjugular intrahepatic portosystemic shunt.…”

“…The TIPS procedure, however, is sometimes followed by complications such as development of acute hepatic encephalopathy seen in up to 8% of patients, which we present in our case [6][7][8]10,11]. Current literature outlines treatments such as pharmacological therapy, shunt occlusion, and shunt reduction to manage the hepatic encephalopathy [10][11][12][13][14][15][16][17]. In our report, we present a unique method of reducing the TIPS by constraining the existing stent with a single balloon-expandable stent.…”