Complications of transjugular intrahepatic portosystemic shunt.

1. Hematoma at the neck puncture point: Due to improper compression or injury to the carotid artery during jugular vein puncture, special treatment is generally not needed, but the hematoma at the initial stage of the operation is large, which may affect the smooth operation, so the author advocates jugular vein puncture under the guidance of B-ultrasound.

2. Intrahepatic bile duct injury or portal biliary fistula: This situation can lead to early stent occlusion.

3. Ectopic or falling off of stent tube: It often occurs in balloon stent expansion, which is mostly caused by the rupture of balloon wall during balloon expansion or the detachment of balloon catheter after expansion.

4. Stent stenosis and occlusion: most of them are caused by early postoperative embolization, and about 4%-5% of patients appear. Anticoagulation therapy within 6 hours after operation can reduce platelet aggregation, which is very important to prevent stenosis and occlusion after early embolization. Doppler ultrasound should be performed 24 hours after operation to check the patency of the stent, and the stent should be expanded in time if any abnormality is found. .

5. Hepatic encephalopathy: the most important complication of TIPS. According to the literature, the incidence of hepatic encephalopathy is about 20% in selective portosystemic shunt and as high as 50% in non-selective shunt. TIPS is similar to selective portal vein shunt. The occurrence of hepatic encephalopathy is related to preoperative liver function, liver hemodynamics and TIPS diameter, but it seems to have little to do with the patient's age. At present, the clinical data can not explain the exact effect of TIPS on hepatic encephalopathy, but the incidence of hepatic encephalopathy after TIPS is relatively low, which has been affirmed by most literatures.