TRANSJUGULAR INTRAHEPATIC PORTAL-SYSTEMIC SHUNT FOR THE MANAGEMENT OFSYMPTOMATIC CIRRHOTIC HYDROTHORAX

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.