Rm. Strauss et al., TRANSJUGULAR INTRAHEPATIC PORTAL-SYSTEMIC SHUNT FOR THE MANAGEMENT OFSYMPTOMATIC CIRRHOTIC HYDROTHORAX, The American journal of gastroenterology, 89(9), 1994, pp. 1520-1522
Objective: To investigate the safety and effectiveness of performing t
ransjugular intrahepatic portal systemic shunt (TIPS) for the manageme
nt of symptomatic cirrhotic hydrothorax in patients with advanced cirr
hosis. Methods: TIPS was performed by standard technique after portal
vein patency had been established by ultrasound. Portal-hepatic vein p
ressure gradient was determined before and after placement of the shun
t. A portal-hepatic vein gradient of less than 12 mm Hg was the treatm
ent goal. Results: Five patients underwent TIPS placement over an 11-m
onth period. Despite use of diuretics, the patients had required a med
ian of seven thoracenteses (range 2-11) for control of symptoms preced
ing placement of the shunt. A TIPS was placed without serious complica
tions in all five patients. In two patients, insertion of the shunt wa
s associated with no further need for thoracentesis, The other three p
atients had recurrent need for thoracentesis. These three patients wer
e found to have occluded shunts which were rendered patent by angiopla
sty and/or urokinase. Subsequently, two required no further thoracente
sis, whereas, in the other patient, the need for thoracentesis was dec
reased dramatically. Conclusions: TIPS appears to be a safe and useful
technique for the management of patients with symptomatic cirrhotic h
ydrothorax that is refractory to medical therapy. Recurrence of the pl
eural effusion after placement of TIPS may be an indication of shunt o
cclusion.