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CardioVascular and Interventional Radiology
Erschienen in: CardioVascular and Interventional Radiology 2/2016

01.02.2016 | Review

Endovascular Management of Refractory Hepatic Encephalopathy Complication of Transjugular Intrahepatic Portosystemic Shunt (TIPS): Comprehensive Review and Clinical Practice Algorithm

verfasst von: Keith Pereira, Andres F. Carrion, Jason Salsamendi, Mehul Doshi, Reginald Baker, Issam Kably

Erschienen in: CardioVascular and Interventional Radiology | Ausgabe 2/2016

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Abstract

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.
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Metadaten
Titel
Endovascular Management of Refractory Hepatic Encephalopathy Complication of Transjugular Intrahepatic Portosystemic Shunt (TIPS): Comprehensive Review and Clinical Practice Algorithm
verfasst von
Keith Pereira
Andres F. Carrion
Jason Salsamendi
Mehul Doshi
Reginald Baker
Issam Kably
Publikationsdatum
01.02.2016
Verlag
Springer US
Erschienen in
CardioVascular and Interventional Radiology / Ausgabe 2/2016
Print ISSN: 0174-1551
Elektronische ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-015-1197-x

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