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- Title
Current diagnosis and management of post-transjugular intrahepatic portosystemic shunt refractory hepatic encephalopathy.
- Authors
Pereira, Keith; Carrion, Andres F.; Martin, Paul; Vaheesan, Kirubahara; Salsamendi, Jason; Doshi, Mehul; Yrizarry, Jose M.
- Abstract
Transjugular intrahepatic portosystemic shunt has evolved into an important option for management of complications of portal hypertension. The use of polytetrafluoroethylene covered stents enhances shunt patency. Hepatic encephalopathy (HE) remains a significant problem after TIPS placement. The approach to management of patients with refractory hepatic encephalopathy typically requires collaboration between different specialties. Patient selection for TIPS requires careful evaluation of risk factors for HE. TIPS procedure-related technical factors like stent size, attention to portosystemic pressure gradient reduction and use of adjunctive variceal embolization maybe important. Conservative medical therapy in combination with endovascular therapies often results in resolution or substantial reduction of symptoms. Liver transplantation is, however, the ultimate treatment.
- Subjects
HEPATIC encephalopathy; SURGICAL anastomosis; PORTAL hypertension; NEUROBEHAVIORAL disorders; NEUROTOXIC agents; DIAGNOSIS; THERAPEUTICS
- Publication
Liver International, 2015, Vol 35, Issue 12, p2487
- ISSN
1478-3223
- Publication type
Article
- DOI
10.1111/liv.12956