Gk. Nazarian et al., REFRACTORY ASCITES - MIDTERM RESULTS OF TREATMENT WITH A TRANSJUGULARINTRAHEPATIC PORTOSYSTEMIC SHUNT, Radiology, 205(1), 1997, pp. 173-180
PURPOSE: To assess midterm results and examine factors associated with
successful treatment of refractory ascites with creation of a transju
gular intrahepatic portosystemic shunt (TIPS). MATERIALS AND METHODS:
In 50 patients with refractory ascites, TIPS creation was performed. C
linical and ultrasound follow-up were performed. Success was defined a
s survival with no further therapeutic paracentesis and decreased asci
tes. RESULTS: Mean follow-up was 11.6 months after the TIPS procedure.
Major complications occurred in 16% of patients including intraperito
neal hemorrhage, refractory encephalopathy, and progression of liver a
nd renal failure. Overall mortality was 60% (30 patients). In 23 (62%)
of 37 patients not lost to follow-up, ascites was controlled successf
ully at 1-3 months. A bilirubin level greater than 3.0 mg/dL (52 mu mo
l/L) and creatinine level greater than 1.9 mg/dL (170 mu mol/L) were a
ssociated with treatment failure (86% treatment failure at 3 months) a
nd early mortality (P = .03). In all 14 patients alive at 1-year follo
w-up, ascites was controlled successfully. CONCLUSION: TIPS creation i
s often useful in treatment of severe ascites not controlled with medi
cal therapy. In patients with advanced liver and renal failure, TIPS c
reation is not associated with a definite benefit and may hasten death
.