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    Thus, TIPS catheterization or upper endoscopy should be considered one year after TIPS performance  TIPS is effective in control of acute bleeding from varices that are refractory to medical therapy and should be performed rather than surgery  TIPS is effective in preventing re-bleeding from gastric or ectopic varices and should be preferred for the prevention of re-bleeding in these patients  In patients with portal hypertensive gastropathy, a TIPS should only be performed in case of recurrent bleeding despite -blocker therapy  TIPS is ineffective in bleeding control from gastric antral test viagra internet vascular ectasia and is therefore not recommended  TIPS is effective in the therapy of hepatic hydrothorax but should be only used in case of therapy failure of diuretics and sodium restriction  The use of TIPS for the therapy of hepato-renal syndrome type I is of investigatory use 202 Falk Rauchfuss and Utz Settmacher Table 1. Continued Use of TIPS in the treatment of hepato-pulmonary syndrome is not recommended Evidence level III (Opinions of respected authorities, descriptive epidemiology)  Performance of TIPS only by experienced radiologists (or specially trained physicians). Doppler ultrasound in regular intervals) Evidence level II-1  Target values.  Reduction in hepatic venous pressure gradient to less than 12 mmHg when indication are bleeding esophageal varices  Reduction in hepatic venous pressure gradient when indication is therapy refractory ascites is unclear, but hepatic venous pressure gradient less than 9 mmHg should be achieved  In patients with a high expected 30-days-mortality, TIPS should only be performed in the absence of other options  In case of ultrasound findings indicating TIPS dysfunction or in case of complications caused by a recurrence of portal hypertension, a shunt venography or intervention should be contemplated Evidence level II-6  TIPS performers should be aware of potential complications and should be experienced in complication management  TIPS stenosis is common in bare stents, which is often not reflected in ultrasound.

    Monitoring of success and complication rates, in case of failure review of the program  TIPS indication should be reached in a team decision of gastroenterologist/hepatologist, interventional radiologist and, if possible, transplantation surgeons  Before TIPS, tests of liver and kidney function as well as imaging of the liver should be performed (exclusion of liver masses.