ENCEPHALOPATHY AFTER TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNTING- ANALYSIS OF INCIDENCE AND POTENTIAL RISK-FACTORS

OBJECTIVE. Our purpose was to estimate the incidence of encephalopathy after transjugular intrahepatic portosystemic shunting (TIPS) related primarily to the diversion of portal vein blood flow and to identify periprocedural factors to predict patients at risk. MATERIALS AND METH ODS. All patients who underwent TIPS with at least 1 month of clinical observation after the procedure were monitored for clinically evident encephalopathy. Other variables that could individually induce enceph alopathy were retrospectively analyzed for interrelationships with spo ntaneous or worsened encephalopathy. RESULTS. Of the 150 patients, 68 (45%) suffered from encephalopathy after TIPS, but in only 33 (22%) wa s it new or worse than baseline measurements obtained before TIPS; in 18 of these 33 patients, an underlying medical cause was implicated, F ifteen (10%) of the 150 patients developed mental dysfunction, usually mild and well controlled, thought to be related only to TIPS and not to any underlying morbidity, Low port al vein pressures after TIPS wer e found to be interrelated with new or worsened spontaneous encephalop athy (p = .04). Like wise, advanced age (>59 years old) weakly corresp onded to the development of encephalopathy after TIPS. CONCLUSION. TIP S causes an acceptably low rate of encephalopathy that is usually mild . No specific variables exist for predicting the development or progre ssion of encephalopathy after TIPS.