Splenic Embolization for Recalcitrant Post-TIPS Encephalopathy

Encephalopathy in the setting of transjugular portosystemic shunts (TIPS) is a difficult clinical problem. Shunt reduction often improves encephalopathy but increases the risk of portal hypertension related complications. In this case we describe the use of partial splenic artery embolization in a 60-year-old female who presented with both TIPS dysfunction and refractory encephalopathy. Prior to treatment the patient had an elevated TIPS gradiant, visible varices by endoscopy, and encephalopathy that was severe and refractory enough to be considered for hospice. Following 60% splenic volume embolization, encephalopathy resolved, varices decompressed, and patient was able to be discharged home. This demonstrates that splenic embolization may be considered as a potential alternative to TIPS reduction in the setting of TIPS dysfunction and encephalopathy.