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Đề nghị chương trình giám sát liên tục là một máy quét lặp lại trong sáu tuần, ba tháng, sáu tháng và một năm. Bất cứ bằng chứng lâm sàng của rối loạn chức năng ống đỡ động mạch dẫn đến siêu âm khẩn cấp. | 894 G. Conder W. Gedroyc performed within 24 h of the procedure.25 26 This will also pick up other early complications such as haemoperitoneum hepatic haematoma and hepatic infarction. The suggested ongoing surveillance program is a repeat scan at six weeks three months six months and one year. Any clinical evidence of stent dysfunction should lead to an urgent ultrasound. However ultrasound may be a good positive predictor of dysfunction but is a poor negative predictor and TIPS venography remains the gold standard to be performed in any case of clinical evidence or dysfunction even in the case of a normal ultrasound. If a stenosis is found the stent can be decompressed at this time.25 26 Owing to ultrasound being a poor screening tool coupled with the catastrophic consequences or a variceal re-bleed some authorities recommend six monthly venograms for the first three years.32 In the event of dysfunction a percutaneous a recannulation can be attempted in the case of TIPS stenosis. If this fails a new TIPS may be inserted and failing that a surgical shunt can be considered. There is ongoing research in the prevention of stent dysfunction including use of covered stents anti-platelet derived growth factor and brachytherapy.25 The other major complication of TIPS is hepatic encephalopathy which has a multifactorial aetiology predominately related to bypassing the liver by portal blood flow through the TIPS and the increased bioavailablity of gut-related toxins that the liver would normally filter out from the systemic circulation. The incidence of new or worsening encephalopathy following TIPS has been reported as 20-31 .26 33 The pre-procedure risk factors for post-TIPS encephalopathy include pre-TIPS encephalopathy increased age low albumin low post-TIPS portosystemic gradient severe underlying liver disease and non-alcoholic cirrhosis.25 The treatment of post-TIPS hepatic encephalopathy includes the treatment of any co-existent medical pathology such as infection
