If a patient has persistent ascites requiring diuretics after TIPS, at what point do you consider re-evaluation of TIPS?

Some may still require some diuretics, particularly if lower extremity edema is an issue post-TIPS. Otherwise, if paracentesis is needed ~6 weeks after TIPS and the patient is free of HE, then consider IR dilating the TIPS further. When TIPS is for ascites, IR should really start with a small calibe...

First, I always review the TIPS procedure report and make note of the initial HVPG that was measured prior to TIPS placement, the diameter that the TIPS stent was opened to, and the post-TIPS HVPG measured. If the initial HVPG is <10 mmHg, I would question the etiology of the liver disease, as this ...

Certainly, there are cases where even a TIPS well placed with an appropriate drop in pressure gradient to around 6-8 mmHg may not work, in particular when they have seriously impaired renal function. But in most cases, I check at least once with an ultrasound with Doppler to assess velocities and TI...