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.