A number of changes may indicate that a transjugular intrahepatic portosystemic stent shunt (TIPS) may not be functioning properly.


Patient selection: presence of a TIPS placed for portal hypertension


Features suggesting TIPS dysfunction:

(1) portal flow velocity through the shunt by Doppler ultrasonography is < 50% of flow velocity after initial placement

(2) presence of esophageal varices > 5 mm in diameter at endoscopy (high risk varices)

(3) occurrence of rebleeding from esophageal varices


If TIPS dysfunction is suspected, then the shunt can be catheterized and assessed for obstruction or stenosis. A stenosis is suggested by a portal pressure gradient (PPG) > 12 mm Hg.


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