Unique Method of Transjugular Intrahepatic Portosystemic Shunt Reduction for Refractory Hepatic Encephalopathy

Area of Science:

• Interventional Radiology
• Hepatology
• Gastroenterology

Background:

• Cryptogenic cirrhosis can lead to severe complications like bleeding esophageal varices.
• Transjugular intrahepatic portosystemic shunt (TIPS) is a treatment for portal hypertension but can cause complications such as hepatic encephalopathy.
• Refractory varices and hepatic encephalopathy pose significant management challenges in cirrhosis patients.

Observation:

• A 27-year-old female with cryptogenic cirrhosis presented with refractory bleeding esophageal varices requiring emergent TIPS placement.
• The patient subsequently developed acute intermittent hepatic encephalopathy, necessitating TIPS reduction.
• Interventional radiology successfully reduced the TIPS using a novel technique involving a single Viabahn VBX stent.

Findings:

• The TIPS reduction procedure utilizing a single Viabahn VBX stent was technically successful.
• Following the TIPS reduction, the patient's hepatic encephalopathy symptoms significantly improved.
• This minimally invasive technique effectively managed a complex complication of TIPS placement.

Implications:

• This case highlights a unique and effective method for TIPS reduction in managing hepatic encephalopathy.
• The use of a Viabahn VBX stent offers a potential solution for recalibrating TIPS in patients with refractory complications.
• Interventional radiology plays a crucial role in managing advanced liver disease complications through innovative procedures.