Bart De Keyzer MD, Presenter: Nothing to Disclose

Frederik Nevens MD, PhD, Abstract Co-Author: Nothing to Disclose

Sam Heye MD, Abstract Co-Author: Nothing to Disclose

Johan Vaninbroukx MD, Abstract Co-Author: Nothing to Disclose

Chris Verslype MD, PhD, Abstract Co-Author: Nothing to Disclose

David Cassiman MD, PhD, Abstract Co-Author: Nothing to Disclose

Wim Laleman, Abstract Co-Author: Nothing to Disclose

Geert Maleux MD, PhD, Abstract Co-Author: Nothing to Disclose

Transjugular intrahepatic portosystemic shunt (TIPS) placement became the standard treatment for a subcategory of patients with refractory ascites and variceal bleeding. It has the disadvantage of provoking chronic hepatic encephalopathy (HE) and, in some patients with limited liver function, TIPS-induced liver failure (LF). Reduction of the diameter of the TIPS stent is feasible by the parallel technique. However, the experience is still limited.

TIPS reduction was performed by the placement of a 10 mm self-expanding stent along with a 5-6-7 mm balloon-expandable stent. After a learning group of 17 patients (Maleux G, JVIR 2007), 55 patients were included in this prospective study. Baseline characteristics included age, gender, cause of cirrhosis, MELD score, indication for TIPS, time interval between TIPS and reduction, and pressure gradient before and after reduction.

Patients with medical therapy resistant chronic HE: improvement of HE = 25/34 (74%), recurrence of initial indication = 9/34 (26%) and six month survival = 29/34 (85%). Patients with TIPS-induced liver failure: improvement 11/21 (52%) and survival 11/21 (52%), three of these patients received a liver transplantation.

Stent reductions with the parallel technique improved chronic hepatic encephalopathy in 74% of the patients and offered them a 6 months survival of 85%. In patients who developed TIPS-induced liver failure, 52% recovered and for this group, TIPS reduction can serve as a bridge to liver transplantation.

TIPS-induced hepatic encephalopathy refractory to medical therapy can be improved by shunt reducing techniques in a majority of cases.

De Keyzer, B, Nevens, F, Heye, S, Vaninbroukx, J, Verslype, C, Cassiman, D, Laleman, W, Maleux, G, The Outcome of Shunt Reduction after TIPS by the Parallel Technique: A Prospective Study.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13013373.html