Before TIPS, confirm portal and hepatic vein patency and anatomy; after it, Doppler shows flow toward the heart through the stent with velocities in the expected range and reversed flow in the portal branches — a change from baseline flags dysfunction.
Orient first
- Indications: refractory variceal bleeding and refractory ascites.
- Covered stents have largely solved early stenosis; a baseline Doppler is the reference for later studies.
- Hepatic encephalopathy and heart failure are the clinical costs.
Acquire the study
- Curvilinear probe with colour and spectral Doppler; angle-corrected velocities in the portal vein, proximal, mid and distal stent.
The manoeuvre
- Stent velocities in cm/s at the portal end, mid and hepatic venous end — compare with the baseline study.
- Main portal vein velocity; flow direction in the right and left portal branches (toward the stent).
- Hepatic vein at the outflow: stenosis or thrombus.
- Ascites and varices.
What confirms it
- Patent stent with hepatopetal portal flow into the stent and velocities stable from baseline.
What licenses you to exclude it
- Stable stent velocities and flow directions compared with the baseline make dysfunction unlikely.
The classic misread
- Interpreting a single velocity without the baseline.
- Missing a hepatic venous outflow stenosis beyond the stent end.