Endovascular Management of Refractory Hepatic Encephalopathy Complication of Transjugular Intrahepatic Portosystemic Shunt (TIPS): Comprehensive Review and Clinical Practice Algorithm.
Transjugular intrahepatic portosystemic shunt (TIPS) has evolved as an effective intervention for treatment of complications of portal hypertension. The use of polytetrafluoroethylene-covered stents have improved the patency of the shunts and diminished the incidence of TIPS dysfunction. However, TIPS-related refractory hepatic encephalopathy (rHE) poses a significant challenge. Approximately 3-7 % of patients with TIPS develop rHE. Refractory hepatic encephalopathy is defined as a recurrent or persistent encephalopathy despite appropriate medical treatment. Hepatic encephalopathy can be an extremely debilitating complication that profoundly affects quality of life. The approach to management of patients with rHE is complex and typically requires collaboration between different specialties. Liver transplantation is the ultimate treatment for rHE; however, the ongoing shortage of organ donation markedly limits this treatment option. Alternative therapies such as shunt occlusion or reduction can control symptoms and serve as a 'bridge' therapy to liver transplantation. Therefore, interventional radiologists play a key role in the management of these patients by offering a variety of endovascular techniques. The purpose of this review is to highlight some of these endovascular techniques and to develop a therapeutic algorithm that can be applied in clinical practice for the management of rHE.
Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Hospital, Miami, FL, 33140, USA. keithjppereira@gmail.com.
Keith
http://orcid.org/0000-0002-0155-908X
K
Pereira
Department of Hepatology, Jackson Memorial Hospital/University of Miami Hospital, Miami, FL, 33140, USA. andres.carrionmonsa@jhsmiami.org.
Andres F
AF
Carrion
Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Hospital, Miami, FL, 33140, USA. JSalsamendi@med.miami.edu.
Jason
J
Salsamendi
Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Hospital, Miami, FL, 33140, USA. MDoshi@med.miami.edu.
Mehul
M
Doshi
Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Hospital, Miami, FL, 33140, USA. RBaker@med.miami.edu.
Reginald
R
Baker
Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Hospital, Miami, FL, 33140, USA. ikably@med.miami.edu.
Issam
I
Kably
D000465:Algorithms; D019468:Disease Management; D006501:Hepatic Encephalopathy / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects*; D015642:Radiology, Interventional
Endovascular management; Hepatic encephalopathy; Splenic artery embolization; Transjugular intrahepatic portosystemic shunt