title: The reducing stent: treatment for transjugular intrahepatic portosystemic shunt-induced refractory hepatic encephalopathy and liver failure.
abstract: OBJECTIVE
  To examine the efficacy of a stent device in reducing the diameter of transjugular intrahepatic portosystemic shunts (TIPS) in patients with progressive liver failure or with shunt-induced hepatic encephalopathy.
  
  
  METHODS
  Seven patients with TIPS (four with severe hepatic encephalopathy, three with progressive liver failure) underwent transjugular implantation of a stent designed to reduce the flow through the original TIPS channel.
  
  
  RESULTS
  Implantation of the reducing stent proceeded without complication. Duplex sonography showed that stent flow decreased by 41% +/- 18 (mean +/- standard deviation). The four patients with hepatic encephalopathy showed substantial improvement. Concentrations of plasma ammonium and serum bilirubin improved considerably. In contrast, functional impairment progressed in the three patients treated for liver failure. The patients soon died.
  
  
  CONCLUSIONS
  With the limited experience of treating these seven patients, the authors suggest that shunt-induced hepatic encephalopathy can be effectively treated with implantation of a reducing stent. Hepatic failure, however, is a deleterious complication that seems to be irreversible.
authors.affiliation: Department of Radiology, University of Freiburg, Germany.
authors.forename: K H
authors.initials: KH
authors.lastname: Hauenstein
authors.forename: K
authors.initials: K
authors.lastname: Haag
authors.forename: A
authors.initials: A
authors.lastname: Ochs
authors.forename: M
authors.initials: M
authors.lastname: Langer
authors.forename: M
authors.initials: M
authors.lastname: Rössle
mesh_terms: D000368:Aged; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000601:surgery*; D006801:Humans; D017093:Liver Failure / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D015607:Stents