In TIPS (transjugular intrahepatic portosystemic shunt) procedure for refractory ascites, the target post-procedure portosystemic pressure gradient (PPG) is:

• A Reduction to <5 mmHg regardless of pre-procedure gradient
• B Complete abolition of portal hypertension (0 mmHg)
• C Reduction by >50% of the pre-procedure gradient, irrespective of absolute value
• D Reduction to <12 mmHg (from typically >20 mmHg pre-procedure) ✓

Explanation

TIPS creates a communication between the hepatic vein and intrahepatic portal vein, shunting blood from the portal circulation into the systemic venous system to decompress portal hypertension. The target portal pressure gradient (PPG = portal vein pressure minus hepatic vein pressure) post-TIPS for prevention of variceal rebleeding and management of refractory ascites is reduction to <12 mmHg. Most clinical outcomes (variceal rebleeding, resolution of ascites) improve when PPG drops below 12 mmHg. Too aggressive reduction (<5 mmHg) risks precipitating/worsening hepatic encephalopathy. The procedure is performed under fluoroscopic/US guidance via jugular venous access.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.