Use of Partial Splenic Embolization Following a Transjugular Intrahepatic Portosystemic Shunt to Reduce Persistent Portal Hypertension Sequelae

Transjugular intrahepatic portosystemic shunt (TIPS) placement is a well-established intervention for portal hypertension. However, some patients experience persistent complications such as encephalopathy, ascites, or thrombocytopenia, especially when further TIPS optimization is not technically possible. Partial splenic embolization (PSE), typically performed for hypersplenism or certain hematologic conditions, can reduce portal venous inflow and improve cytopenias; however, its use as an adjunct to TIPS is less well described. We present the case of a 73-year-old male with cirrhosis secondary to hepatitis C who developed recurrent ascites, worsening encephalopathy, and refractory thrombocytopenia following portal vein recanalization with TIPS placement 18 months prior. The patient's TIPS could not be further optimized due to technical limitations. Imaging demonstrated marked splenomegaly and an enlarged splenic artery, suggesting increased splenic contribution to portal inflow. PSE of the lower pole was performed. Post-procedure, the patient experienced significant clinical improvement. Encephalopathy episodes resolved, no ascites was seen on follow-up CT, and platelet count rose from <50,000/µL to >100,000//µL. The patient subsequently developed a splenic abscess requiring percutaneous intervention. PSE may serve as an effective adjuvant to TIPS in selected patients with persistent portal hypertension and cytopenias when further TIPS optimization is not possible. This case highlights the potential for PSE to reduce portal inflow and improve platelet count, suggesting an expanded role in the management of complex portal hypertension.