From the Guidelines
The appropriate needle size for a Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure is 10 mm, but it can be initially expanded to 8 mm and then adjusted based on patient comorbidities and TIPS indication.
Key Considerations
- The initial expansion to 8 mm is recommended, followed by a step-wise approach to achieve the target portosystemic gradient (PPG) 1.
- A larger diameter shunt, such as 10 mm, may be necessary in some cases, but it is associated with a greater risk of hepatic encephalopathy (HE) 1.
- The use of controlled expansion stents with a "dial-able" diameter of 8 or 10 mm may allow operators to modulate the encephalopathy rate, but this is not evidence-based 1.
- Targeting post-TIPSS portosystemic gradient values of <12 mmHg or a percentage reduction of 20% may be more practical than aiming for a specific diameter 1.