Efficacy of prophylactic embolization of spontaneous portosystemic shunts on preoperative CT for post-shunt hepatic encephalopathy in cirrhosis

Purpose Overt hepatic encephalopathy (OHE) remains a major complication following transjugular intrahepatic portosystemic shunt (TIPS) in cirrhotic patients. This study aimed to evaluate, from an interventional radiology perspective, whether prophylactic embolization of large spontaneous portosystemic shunts (SPSS) during TIPS creation reduces the incidence of post-procedural OHE. Methods This single-center retrospective cohort study included consecutive cirrhotic patients with large SPSS (diameter ≥8 mm) who underwent elective TIPS between February 2020 and February 2025. Patients were divided into TIPS alone (n = 66) or TIPS with concurrent SPSS embolization (n = 54). Preoperative clinical, laboratory, and radiological characteristics (SPSS diameter, type, and number on contrast-enhanced CT) were documented. Intraoperative hemodynamic parameters (portal vein pressure, portosystemic pressure gradient), procedural details (procedure time, contrast volume, embolization materials), and cumulative OHE incidence at 1, 3, 6, and 12 months postoperatively were assessed. Blood ammonia and liver function were re-evaluated at 3 months. Stent patency, reintervention rates, and serious adverse events were monitored throughout the 1-year follow-up. Results A total of 120 patients were included. The most common shunt type was splenorenal (55.0%), followed by gastrorenal (35.0%) and paraumbilical (10.0%), with no significant differences in distribution between two groups. The 12-month cumulative OHE incidence was significantly lower in TIPS + SPSS embolization group compared to TIPS alone (18.52% vs. 39.39%, P = 0.013). Multivariable analysis identified TIPS without embolization as an independent risk factor for OHE (HR 2.387, 95% CI 1.224–4.652, P = 0.011). At 3 months, blood ammonia levels were lower in embolization group (P = 0.026). Although procedure time and contrast volume were greater with embolization (both P < 0.001), 1-year stent patency, reintervention rates, and adverse event rates did not differ between groups. Conclusion Prophylactic embolization of large SPSS during TIPS creation, as an image-guided interventional radiology maneuver, significantly reduces the 1-year incidence of OHE in cirrhotic patients without increasing serious adverse events.