title: Refractory ascites: early experience in treatment with transjugular intrahepatic portosystemic shunt.
abstract: OBJECTIVE
  To evaluate the transjugular intrahepatic portosystemic shunt (TIPS) in treatment of refractory ascites.
  
  
  METHODS
  Fourteen patients with chronic liver disease and portal hypertension were included in a prospective study. Six patients had Child-Pugh class B disease; eight had class C disease. Indications for TIPS were three previous hospital admissions over 9 months for treatment of tense ascites, no response to diuretic therapy, or an occluded peritoneovenous shunt with tense ascites. The volume of ascitic fluid was sonographically evaluated before and after TIPS placement.
  
  
  RESULTS
  The technical success rate for TIPS creation was 93%. Mean portosystemic gradient decreased from 22.8 mm Hg +/- 7.2 before TIPS placement to 11.3 mm Hg +/- 3.6 after TIPS (P = .005). Complete resolution of ascites was achieved in seven (50%) patients. Treatment failed in seven; five had Child-Pugh class C disease, and four of these had a Child-Pugh score greater than 11.
  
  
  CONCLUSIONS
  These results are comparable to those for other forms of treatment of ascites. The authors do not, however, recommend TIPS in patients with a Child-Pugh score greater than 11.
authors.affiliation: Department of Radiology, UMHC, Minneapolis.
authors.forename: H
authors.initials: H
authors.lastname: Ferral
authors.forename: H
authors.initials: H
authors.lastname: Bjarnason
authors.forename: S A
authors.initials: SA
authors.lastname: Wegryn
authors.forename: G J
authors.initials: GJ
authors.lastname: Rengel
authors.forename: G K
authors.initials: GK
authors.lastname: Nazarian
authors.forename: J M
authors.initials: JM
authors.lastname: Rank
authors.forename: S M
authors.initials: SM
authors.lastname: Tadavarthy
authors.forename: D W
authors.initials: DW
authors.lastname: Hunter
authors.forename: W R
authors.initials: WR
authors.lastname: Castaneda-Zuniga
mesh_terms: D001201:Ascites / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D011168:Portal System / Q000000981:diagnostic imaging; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography