What should the PSG be reduced to for TIPS for variceal bleeding

What should the portosystemic pressure gradient (PSG) be reduced to for TIPS placed for variceal bleeding as opposed to TIPS placed for refractory ascites? 

  • The post-TIPS PSG should be reduced to less than 12 mm Hg to prevent rebleeding episodes.
  • The degree of PSG reduction to control ascites is unclear but a PSG of 12 mm Hg or less is considered an acceptable goal.
  • Gradients of less than 5 mm Hg have been associated with an increased risk of liver failure and severe hepatic encephalopathy requiring an intervention such as TIPS reduction or occlusion.
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