The authors describe an endovascular technique to reduce shunt diameter in the management of transjugular intrahepatic portosystemic shunt (TIPS)-induced refractory hepatic encephalopathy. Five patients were treated with a constrained stent-graft by using a commercially available balloon-expandable stent-graft narrowed by using a lasso catheter. This offers the possibility of an adjustable reduction of the shunt diameter. All procedures were technically successful, resulting in a significant increase in the portosystemic gradient and reopacification of the intrahepatic portal vein branches, findings that correlated with clinical improvement. This technique provides the ability to titrate the portosystemic gradient to the desired endpoint during shunt reduction.
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