Portal Hypertension · IR Playbook

TIPS Reduction or Occlusion for Refractory Hepatic Encephalopathy (TIPS reduction)

Endovascular narrowing (reduction) or complete closure (occlusion) of a patent TIPS in a patient with disabling post-TIPS hepatic encephalopathy or hepatic insufficiency refractory to medical therapy. The mechanism is deliberate restoration of portal perfusion to hepatocytes and reduction of portosystemic shunt fraction by raising shunt resistance, which improves ammonia clearance and hepatic synthetic function but predictably re-elevates the portosystemic gradient and re-exposes the patient to variceal bleeding and ascites. Reduction is therefore preferred over occlusion whenever the original TIPS indication was variceal haemorrhage, since occlusion removes all bleeding protection.

What this playbook covers

• Indications
• Contraindications
• Anatomy and Planning
• Equipment
• Procedure Steps
• Technical Endpoints
• Variants
• Comparisons
• Troubleshooting
• Complications
• Post-procedure Care
• References

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