Clinical Outcomes and Patency after Transjugular Intrahepatic Portosystemic Shunt Reduction for Overshunting Adverse Events

Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation

“…Published data support HE improvement in 55 to 100% of patients after TIPS reduction, 13 39 40 41 42 43 44 45 46 47 48 and reduced shunts show acceptable patency rates approximating 75% at 1 year as well as a low incidence of portal hypertensive complications. 41 If HE persists after TIPS reduction, patients can undergo further shunt modification. 13…”

“…Several techniques can be used for TIPS reduction; shunts may be reduced using a parallel stent and stent-graft technique, 38 an incompletely dilated balloon expandable stent approach, performed either using a suture-constrained balloon for balloon expandable stent dilation 39 or facilitated by delivery sheath controlled stent deployment, 40 and via a "single-stent unmodified covered stent" method. 41 All of these techniques are amenable to customization of PPG through incremental shunt expansion, though the optimal amount of PPG elevation is unknown. Published data support HE improvement in 55 to 100% of patients after TIPS reduction, 13,[39][40][41][42][43][44][45][46][47][48] and reduced shunts show acceptable patency rates approximating 75% at 1 year as well as a low incidence of portal hypertensive complications.…”

“…41 All of these techniques are amenable to customization of PPG through incremental shunt expansion, though the optimal amount of PPG elevation is unknown. Published data support HE improvement in 55 to 100% of patients after TIPS reduction, 13,[39][40][41][42][43][44][45][46][47][48] and reduced shunts show acceptable patency rates approximating 75% at 1 year as well as a low incidence of portal hypertensive complications. 41 If HE persists after TIPS reduction, patients can undergo further shunt modification.…”

Post-Transjugular Intrahepatic Portosystemic Shunt (TIPS) Hepatic Encephalopathy—A Review of the Past Decade’s Literature Focusing on Incidence, Risk Factors, and Prophylaxis

“…Secondary reduction in the stent diameter has been reported to improve HE in some patients with worsening or occurrence of post-TIPS HE without increasing the risk of new variceal bleeding, but often with partial recurrence of ascites [ 35 , 36 , 64 , 128 , 129 , 130 , 131 ]. The studies on the topic report improvement in HE in 80–90% of patients after TIPS reduction, but survival, at least in one study, was only 10% at one year without liver transplantation [ 35 , 129 ]. A single study, however, reported a somewhat lower response rate of 55% [ 131 ].…”