Acute Hepatic Ischemia after Transjugular Intrahepatic Portosystemic Shunt Creation Despite Preserved Arterial Perfusion

Ischemic hepatic injury is a potentially fatal but relatively rare complication of transjugular intrahepatic portosystemic shunt (TIPS) creation. Previous reports have attributed ischemia to hepatic arterial injury in conjunction with decreased portal flow. This letter describes a case of liver ischemic injury after TIPS, which is suggested to be caused by a sharp decrease in the portosystemic gradient (PSG), in an effort to raise the readers’ awareness about this rare but essential phenomenon and to propose effective countermeasures.