Post-TIPS Hepatic Encephalopathy

Transjugular intrahepatic portosystemic shunt (TIPS) procedures may be complicated by hepatic encephalopathy related to excessive shunting of portal venous blood into the systemic circulation without detoxification by the liver parenchyma. Although liver transplantation is the only curative treatment option, only a few patients can benefit from this procedure. In a first step, medical, conservative management is performed. In case of hepatic encephalopathy, refractory to medical management, several interventional techniques are available to reduce the diameter of the TIPS and subsequently, to reduce the volume of shunted portal venous blood. Technical aspects, devices and outcome results of these reduction procedures will be discussed as well as preventive procedures and devices which can be used during initial TIPS procedures.