Portal Hypertension/ Transjugular Intrahepatic Portosystemic Shunt(TIPS) Stent Graft Surveillance Duplex Ultrasound


  • Chronic liver disease
  • Surveillance post TIPS insertion

Contraindications and limitations:

  • Extreme abdominal girth
  • Excessive abdominal gas
  • Site trauma such as open wounds, drain or colostomy, in the scanning area
  • Ventilated patients, shortness of breath or rapid breathing may make it difficult to obtain accurate Doppler recordings
  • Patients that cannot be adequately positioned.

Patient preparation:

  • 2 days prior to the ultrasound, it is advisable for the patient to refrain from eating fatty foods, fizzy drinks or any foods that create bowel irritability or gas.
  • On the day of the ultrasound, fast from food and water for a minimum of 6 hours, refrain from chewing gum and smoking. If medication is required, this can be taken with a small sip of water. WHY? Gas in the bowel creates acoustic shadowing, on ultrasound imaging. Any vessels that sits in this shadow will not be seen, therefore cannot be assessed.


What to wear:

Loose-fitting clothes, for example; elasticated skirt/pants/shorts and a loose-fitting top

Ultrasound study technique:

Ultrasound is a non-invasive diagnostic study. The patient will lie on a bed, with the head of the bed slightly elevated for comfort. Ultrasound gel will be applied to the abdomen, just below the ribs and the xiphisternum (lower chest plate, between the angle of the ribs). An ultrasound probe will be run over the abdomen. Occasionally the sonographer may need to apply pressure to the abdomen, lie them flat in the left decubitus position (on their side) to improve visualisation of the arteries, plus ask the patient to hold their breath, periodically, to accurately assess spectral Doppler waveform velocities. Images will be obtained, and the results documented on a worksheet.

Ultrasound study time:

  • 30-45 minutes
  • PLUS 30-60 minutes EXTRA if post-prandial Doppler flow measurements are required.


A worksheet can be available, if requested. A formal written report will be available within 24 to 48 hours, following the ultrasound examination, Monday to Friday. If the ultrasound findings demonstrate pathology, which may require urgent attention, the referring Doctor will be notified ASAP following the completion of the ultrasound.