Which step is necessary after advancing the needles in the TIPSS procedure?

In the Transjugular Intrahepatic Portosystemic Shunt (TIPSS) procedure, advancing the needles is a critical step in accessing the hepatic and portal venous systems. After advancing the needles, it is essential to take pressure measurements. This is a necessary step because it allows the interventional radiologist to assess the pressure gradient between the portal and the hepatic veins.

Measuring these pressures is crucial for determining the severity of portal hypertension and ensuring that the TIPSS is positioned correctly to decompress the portal system effectively. An adequate pressure gradient indicates that a shunt can be created, whereas an insufficient gradient might suggest that the procedure should not proceed. This assessment is pivotal for the success of the TIPSS procedure since the goal is to reduce the pressures within the portal system to prevent complications such as variceal bleeding.

While the other steps mentioned—installing the injector, administering anesthesia, and taking biopsies—are parts of the overall procedural workflow or different aspects of patient management, they do not directly follow the advancement of the needles in terms of assessing hemodynamic conditions specific to the TIPSS creation. Therefore, pressure measurements taken are the logical and necessary step that follows the needle advancement in this specific context.