Q: What is the treatment of unresolved hepatic encephalopathy following transjugular intrahepatic portosystemic shunt (TIPS)?

Answer: Insertion of ePTFE stent-graft inside the original shunt

In usual cases, post-TIPS encephalopathy symptoms get better with  the use of rifaximin or lactulose. In profound or unresolved Post-TIPS Hepatic Encephalopathy, placement of an hourglass-shaped balloon-expandable polytetrafluoroethylene (ePTFE) stent-graft inside the original shunt resolves symptoms within a day.

Reference:

Fanelli F, Salvatori FM, Rabuffi P, et al. Management of refractory hepatic encephalopathy after insertion of TIPS: long-term results of shunt reduction with hourglass-shaped balloon-expandable stent-graft. AJR Am J Roentgenol. Dec 2009;193(6):1696-702