A novel endovascular adjustable polytetrafluoroethylene-covered stent for the management of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt

Transjugular intrahepatic portosystemic shunt (TIPS) is frequently complicated by hepatic encephalopathy. When medical therapy fails, TIPS narrowing and resultant increase in the portosystemic pressure gradient and blood flow to the liver is performed in order to reverse the encephalopathy. We present a method for reducing the TIPS using a polytetrafluoroethylene-covered balloon expandable stent placed over a self-expanding stent. This results in a narrowed TIPS that not only rapidly increases the portosystemic gradient but also can be adjusted by dilating the balloon expandable stent. This method was successful in narrowing the patient's TIPS, acutely increasing the portosystemic gradient and reversing the hepatic encephalopathy.