EXPERIENCES WITH NOVEL TECHNIQUES FOR REDUCTION OF STENT FLOW IN TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNTS

The transjugular intrahepatic portosystemic shunt (TIPS) may deteriora te liver function and can cause encephalopathy in patients with cirrho sis of the liver. Then reduction of TIPS flow may be required. We here report several attempts to reduce shunt: flow in TIPS-induced encepha lopathy or liver function impairment with novel techniques. Three pati ents with cirrhosis of the liver were investigated: Two with severe re current encephalopathy and one with impaired liver function following TIPS insertion. Insertion of a reducing stent was ineffective to decre ase shunt flow velocity in one patient with severe coagulopathy. Suffi cient reduction of shunt flow was achieved by embolizing the space aro und the hourglass waist of the reducing stent with an occlusion emulsi on. Insertion of a conventional stent within the preexisting TIPS with or without additional embolization reduced TIPS flow in the other pat ients. After reduction of shunt flow encephalopathy improved and liver function returned to the level before TIPS, respectively. During foll ow-up no occlusion of TIPS was observed. Thus, reduction of shunt flow velocity can be achieved by insertion of an additional stent into a c urve-shaped TIPS. Embolization can be helpful to decrease TIPS flow; p articularly in patients with severe coagulopathy. Reduction of TIPS fl ow can correct TIPS-induced complications.