Combined Spontaneous Portosystemic Shunt Embolization and Transjugular Intrahepatic Portosystemic Shunt Creation for Treatment of Hepatic Encephalopathy

This retrospective case series assessed the early effectiveness of combined spontaneous portosystemic shunt (SPSS) embolization and preemptive transjugular intrahepatic portosystemic shunt (TIPS) creation for alleviation of medically refractory hepatic encephalopathy and prevention of portal hypertension complications in liver cirrhosis patients. Eight liver cirrhosis patients (5 men, 3 women; mean age 61 ± 10 years) and HE (overt, n = 7; covert, n = 1) refractory to lactulose and rifaximin therapy who underwent concurrent or staged SPSS embolization and TIPS creation between 2018-2022. The primary outcomes were 3-month improvement in HE and post-procedural HE-related hospitalizations. HE improvement was achieved in 7/8 (87.5%) cases. Among all patients, there was one HE related hospitalization within 90 days which responded to repeat embolization with no further admissions. No patients developed new ascites, variceal hemorrhage, or other portal hypertension complications within 3-months.