What possible complication is associated with transjugular portosystemic shunt (TIPS) placement?

The placement of a transjugular portosystemic shunt (TIPS) is primarily done to diminish portal hypertension by creating a direct connection between the portal and systemic venous circulation. While TIPS can be effective in managing complications of cirrhosis, it can also lead to hepatic encephalopathy as a serious complication.

Hepatic encephalopathy occurs because the shunt bypasses the liver's ability to detoxify blood, resulting in increased levels of neurotoxins, such as ammonia, reaching the brain. Normally, the liver processes these substances, preventing them from entering systemic circulation in significant amounts. However, with a TIPS in place, the blood is diverted, and this leads to decreased hepatic clearance of these toxins. Patients may exhibit confusion, altered consciousness, and neurological deficits as a result.

This risk is particularly concerning in patients with underlying liver dysfunction since they may already have compromised hepatic function. Overall, hepatic encephalopathy is a well-recognized complication related to the use of TIPS, making it crucial for clinicians to monitor affected patients closely after the procedure to manage and mitigate this risk effectively.