{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Wysdom Radio™","title":"Portosystemic Shunt Embolization","html":"<iframe width=\"100%\" height=\"180\" frameborder=\"no\" scrolling=\"no\" seamless src=\"https://share.transistor.fm/e/70099dfa\"></iframe>","width":"100%","height":180,"duration":1283,"description":"This episode breaks down a randomized controlled trial from Hepatology exploring whether prophylactic embolization of large spontaneous portosystemic shunts (SPSS) during TIPS can prevent post-procedural hepatic encephalopathy (HE).\nThe Core Problem: Even successful TIPS can trigger HE by shunting toxins away from the liver, especially in patients with large preexisting SPSS. \nThe Key Strategy: Embolizing SPSS before stent deployment improves visualization and avoids catastrophic coil migration after portal decompression. \nA High-Impact Result: Overt HE was cut nearly in half (21% vs. 48%), with a remarkable number needed to treat (NNT) of just 4. \nNo Increased Bleeding Risk: Closing these shunts did not increase variceal rebleeding or compromise TIPS function. \nThe Trade-Off: The procedure adds time and briefly increases portal pressure, requiring operator confidence and careful execution. \nThe Bottom Line: In a highly selected subset of patients, combining TIPS with SPSS embolization is a powerful, anatomy-driven approach to reduce HE risk.\nTune in to learn when this added step is worth it!","thumbnail_url":"https://img.transistorcdn.com/MTWsVlQNVWnqK7R-Z-jI7G_aa5KttFr_japy-P3mayc/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS81ODli/OTVlYjRiZjJlZGZi/ZDQxYmE2NDU2YmUx/Y2ZhMy5qcGc.webp","thumbnail_width":300,"thumbnail_height":300}