A 58-year-old man underwent TIPS six months ago for refractory ascites. Surveillance Doppler ultrasound now shows low velocity flow in the shunt with reversal of flow in the intrahepatic portal vein branches. Recurrent ascites has developed. What does this pattern indicate?
- A Normal post-TIPS haemodynamics requiring no action
- B Shunt stenosis or occlusion with recurrent portal hypertension ✓
- C Hepatic artery pseudoaneurysm
- D Hepatofugal flow confirming successful decompression
Correct answer: B. Shunt stenosis or occlusion with recurrent portal hypertension
Explanation
A functioning TIPS shows continuous hepatopetal flow into the shunt with velocity roughly between 90 and 190 cm/s. Low velocity, absent flow, or reversal of portal branch flow indicates shunt dysfunction, which clinically presents as recurrent ascites or variceal bleeding. Confirmation is by direct portography with gradient measurement, followed by angioplasty or restenting. Successful decompression produces hepatopetal flow toward the shunt, not reversed intrahepatic portal flow.
Reference: Grainger and Allison's Diagnostic Radiology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.