What are the short term and long term goals of TIPS creation?
Successful TIPS creation is associated with a final portosystemic pressure gradient measurement of <12 mm Hg to prevent variceal bleeding or ascites. Successful TIPS creation will prevent variceal bleeding in greater than 90% of cases and will improve or eliminate ascites in greater than 80%. If the patient has significant encephalopathy, and treatment with lactulose is insufficient to control symptoms, a reducing stent may be placed to narrow the TIPS and create an intentional small increase in the portosystemic pressure gradient. TIPS patency may be monitored at intervals using duplex Doppler US, which allows for velocity measurements within the TIPS to be obtained noninvasively. Significant velocity increases from baseline may indicate the presence of TIPS stenosis, which may prompt TIPS venography and revision by balloon dilation or additional stent placement.