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TIPS-related Hepatic Encephalopathy: Management Options with Novel Endovascular Techniques¹

¹ From the Division of Diagnostic Imaging, Section of Vascular and Interventional Radiology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 325, Houston, TX 77030-4009 (D.C.M., M.J.W., K.A.); and North County Radiology, Vista, Calif (R.R.S.). Presented as an education exhibit at the 2002 RSNA scientific assembly. Received February 6, 2003; revision requested April 23 and received June 5; accepted June 9. Address correspondence to D.C.M. (e-mail: dmadoff@di.mdacc.tmc.edu).

Hepatic encephalopathy is a common complication that develops after creation of a transjugular intrahepatic portosystemic shunt (TIPS). Although most patients respond well to conservative medical therapy (ie, protein-restricted diet, nonabsorbable disaccharides, nonabsorbable antibiotics), a small percentage of patients (3%–7%) do not benefit from these methods and require more invasive therapeutic approaches. One option is emergent liver transplantation, but the majority of patients are not suitable candidates. Recently, various percutaneous techniques have been described that alter the hemodynamics through the shunt by occluding it with coils or balloons or by reducing its diameter by inserting constrained stents or stent-grafts. Other techniques have been used for patients with TIPS-related hepatic encephalopathy in whom spontaneous splenorenal shunts are present. In many patients with refractory hepatic encephalopathy, these percutaneous techniques have produced symptomatic improvement, with either a complete resolution or a substantial reduction in hepatic encephalopathy symptoms that can be controlled with medical therapy. Unfortunately, despite all attempts, some patients remain incapacitated and ultimately die. Further research is necessary to improve our understanding of TIPS-related hepatic encephalopathy so that newer, less invasive and safer procedures can be developed to treat this difficult clinical problem.

© RSNA, 2004

Index Terms: Brain, diseases, 10.458 • Hypertension, portal, 957.711 • Liver, interventional procedures, 761.126, 957.458, 957.1268 • Shunts, portosystemic, 761.126, 957.458, 957.1268

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