The purpose of a new study published in Zietschrift fur Gastroenterologie was to determine the accuracy and necessity of long-term Doppler ultrasound (DU) surveillance of trans-jugular intrahepatic portosystemic shunt (TIPS) patency after implantation of an ePTFE-covered stent-graft. This single-center retrospective study recruited 228 consecutive cirrhotic patients with TIPS implantation due to portal hypertensive complications. Standardized DU surveillance was scheduled 3-5 days, 3 months, and 6 months after TIPS implantation and every 6 months thereafter. Portal venography was performed in case, DU findings were suspicious of TIPS dysfunction, clinical signs of recurrent portal hypertension or refractory hepatic encephalopathy. Overall, 866 DU examinations were performed. The results revealed 22 cases of TIPS dysfunction in 16 patients with no first dysfunction more than 4 years after implantation. While routine DU in asymptomatic patients had negligible therapeutic impact. Additionally, DU and venography were concordant in 84.8 % paired examinations, and 1-, 2-, and 5-year primary TIPS patency was 87.4 %, 83.7 %, and 79.97 %, respectively. On the other hand, patients with TIPS dysfunction and subsequent successful revision during the first 2 years of follow-up had a significantly higher risk of new dysfunction compared to those without TIPS dysfunction. Cumulative 1-, 2-, and 5-year survival was 68.7 %, 61.3 %, and 42.7 %, respectively. Therefore, despite acceptable accuracy, scheduled DU surveillance proved to have minor therapeutic impact. Hence, it was concluded that detailed DU surveillance is not useful in asymptomatic patients after 2 years of unremarkable follow-up. Long-term DU surveillance should be performed in patients after successful revision of TIPS dysfunction and patients with prothrombotic states, such as in portal vein thrombosis, Budd-Chiari syndrome.