Who is a good candidate for TIPS?

Good candidates include patients with complications of portal hypertension, such as recurrent variceal bleeding that does not respond to endoscopic therapy, or refractory ascites requiring frequent paracentesis. TIPS is also used for hepatic hydrothorax or Budd-Chiari syndrome. Contraindications include severe liver failure (high MELD score >18–20), uncontrolled systemic infection, severe heart failure, and extensive portal vein thrombosis. A thorough pre-procedure evaluation by a hepatologist is essential to determine suitability.