TIPS Revision: Indications, Techniques, and What to Consider When Revision Fails.

To review the current indications, surveillance strategies, and technical approaches for transjugular intrahepatic portosystemic shunt (TIPS) revision, with emphasis on ultrasound surveillance limitations, surveillance models, and management of refractory complications, including novel approaches such as parallel TIPS. Comprehensive review of current literature on TIPS revision procedures, surveillance protocols, and management of TIPS-related complications. TIPS dysfunction occurs in 10%-20% of patients within the first year despite covered stent technology. Ultrasound surveillance remains the cornerstone of monitoring but has significant limitations. Novel approaches including parallel TIPS placement and advanced management strategies for refractory ascites show promising results. TIPS revision requires careful patient selection, optimized surveillance protocols, and advanced technical expertise. Emerging technologies and treatment paradigms continue to evolve, improving outcomes for patients with complex portal hypertensive complications.