The main complication of a transjugular intrahepatic portosystemic shunt (TIPS) procedure is which of the following?

• A. Increased portal pressures resulting in further esophageal varices
• B. Increased portal pressures resulting in a worsening of cirrhosis
• C. Budd-Chiari syndrome
• D. Increased risk of encephalopathy

Answer: (D)

Diverting portal blood away from the liver reduces hepatic clearance of gut-derived toxins, so hepatic encephalopathy becomes the principal complication after a TIPS. By creating a low-resistance channel between the portal and hepatic venous systems, the procedure lowers portal pressure and helps control variceal bleeding and refractory ascites. But this shunt bypasses the liver’s detoxification, allowing ammonia and other neurotoxins to circulate systemically, which can lead to confusion, changes in mental status, and asterixis, especially in patients with existing liver dysfunction.

Other options don’t fit as the main issue because the goal of TIPS is to decrease, not increase, portal pressure, and it isn’t a direct cause of worsening cirrhosis. Budd-Chiari syndrome is hepatic vein obstruction unrelated to the shunt itself, and while shunt dysfunction or other complications can occur, the most characteristic and common problem is hepatic encephalopathy due to reduced hepatic detoxification.