TY - JOUR
T1 - TIPS-related Hepatic Encephalopathy
T2 - Management Options with Novel Endovascular Techniques
AU - Madoff, David C.
AU - Wallace, Michael J.
AU - Ahrar, Kamran
AU - Saxon, Richard R.
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2004
Y1 - 2004
N2 - 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 stem-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.
AB - 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 stem-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.
KW - Brain, diseases, 10.458
KW - Hypertension, portal, 957.711
KW - Liver, interventional procedures, 761.126, 957.458, 957.1268
KW - Shunts, portosystemic, 761.126, 957.458, 957.1268
UR - http://www.scopus.com/inward/record.url?scp=1642578811&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=1642578811&partnerID=8YFLogxK
U2 - 10.1148/rg.241035028
DO - 10.1148/rg.241035028
M3 - Review article
C2 - 14730033
AN - SCOPUS:1642578811
SN - 0271-5333
VL - 24
SP - 21
EP - 36
JO - Radiographics
JF - Radiographics
IS - 1
ER -