Radiology, Vol 194, 175-179, Copyright © 1995 by Radiological Society of North America
The reducing stent: treatment for transjugular intrahepatic portosystemic shunt-induced refractory hepatic encephalopathy and liver failure
KH Hauenstein, K Haag, A Ochs, M Langer and M Rossle
Department of Radiology, University of Freiburg, Germany.
PURPOSE: To examine the efficacy of a stent device in reducing the diameter
of transjugular intrahepatic portosystemic shunts (TIPS) in patients with
progressive liver failure or with shunt-induced hepatic encephalopathy.
MATERIALS AND METHODS: Seven patients with TIPS (four with severe hepatic
encephalopathy, three with progressive liver failure) underwent
transjugular implantation of a stent designed to reduce the flow through
the original TIPS channel. RESULTS: Implantation of the reducing stent
proceeded without complication. Duplex sonography showed that stent flow
decreased by 41% +/- 18 (mean +/- standard deviation). The four patients
with hepatic encephalopathy showed substantial improvement. Concentrations
of plasma ammonium and serum bilirubin improved considerably. In contrast,
functional impairment progressed in the three patients treated for liver
failure. The patients soon died. CONCLUSION: With the limited experience of
treating these seven patients, the authors suggest that shunt-induced
hepatic encephalopathy can be effectively treated with implantation of a
reducing stent. Hepatic failure, however, is a deleterious complication
that seems to be irreversible.
