Transjugular intrahepatic portosystemic shunt (TIPS) creation is effective in treating the sequelae of decompensated liver cirrhosis—including medically refractory ascites and variceal bleeding—by decompressing the portal venous system through a manmade portosystemic conduit within the liver. However, the altered physiology in which splenomesenteric blood bypasses intrahepatic portal venous perfusion can precipitate varying degrees of hepatic encephalopathy (HE). While the majority of post-TIPS HE cases can be treated medically, some require escalated management strategies, including endovascular interventions to modify the indwelling TIPS and/or occlude competitive physiologic spontaneous portosystemic shunts. This review article details the epidemiology, risk factors, diagnosis, classification, and treatment of post-TIPS HE.

R.C.G. received (prior 36 months) research grants from U.S. National Institutes of Health (active), Society of Interventional Radiology (active), Guerbet USA LLC (active), U.S. Department of Defense (inactive), Janssen Research & Development LLC (inactive), NeoTherma Oncology (inactive), TriSalus Life Sciences (inactive); consultant/advisor for Sus Clinicals Inc. and Astellas Pharma. No other authors have disclosures.

*Both authors contributed equally to this work.

Article published online:
04 May 2023

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