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.
journal_name
Cardiovasc Intervent Radioljournal_title
Cardiovascular and interventional radiologyauthors
Pereira K,Carrion AF,Salsamendi J,Doshi M,Baker R,Kably Idoi
10.1007/s00270-015-1197-xsubject
Has Abstractpub_date
2016-02-01 00:00:00pages
170-82issue
2eissn
0174-1551issn
1432-086Xpii
10.1007/s00270-015-1197-xjournal_volume
39pub_type
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pub_type: 临床试验,杂志文章
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