The transjugular intrahepatic
portosystemic shunt (
TIPS) may deteriorate liver function and can cause
encephalopathy in patients with
cirrhosis of the liver. Then reduction of
TIPS flow may be required. We here report several attempts to reduce shunt flow in
TIPS-induced
encephalopathy or liver function impairment with novel techniques. Three patients with
cirrhosis of the liver were investigated: Two with severe recurrent
encephalopathy and one with impaired liver function following
TIPS insertion. Insertion of a reducing
stent was ineffective to decrease shunt flow velocity in one patient with severe coagulopathy. Sufficient reduction of shunt flow was achieved by embolizing the space around the hourglass waist of the reducing
stent with an occlusion
emulsion. Insertion of a conventional
stent within the preexisting
TIPS with or without additional embolization reduced
TIPS flow in the other patients. After reduction of shunt flow
encephalopathy improved and liver function returned to the level before
TIPS, respectively. During follow-up no occlusion of
TIPS was observed. Thus, reduction of shunt flow velocity can be achieved by insertion of an additional
stent into a curve-shaped
TIPS. Embolization can be helpful to decrease
TIPS flow, particularly in patients with severe coagulopathy. Reduction of
TIPS flow can correct
TIPS-induced complications.