Severe ascites: efficacy of the transjugular intrahepatic portosystemic shunt in treatment.
OBJECTIVE
To evaluate the transjugular intrahepatic portosystemic shunt (TIPS) as primary treatment in patients with cirrhosis and severe ascites.


METHODS
A TIPS placement was attempted in 54 consecutive patients with intractable ascites. Clinical assessment findings, shunt patency, complications, and survival were analyzed.


RESULTS
A TIPS was successfully placed in 50 patients (93%). Follow-up for clinical effectiveness in 51 patients was a mean of 285 days (range, 1-981 days). Forty patients (78%) gained clinical benefit from the shunt. Of these, 29 (57%) had a complete response (required no further paracentesis) and 11 patients (22%) had a partial response (required less frequent but additional paracentesis for control of ascites). The absence of preprocedure renal insufficiency (creatinine < 1.5 mg/dL [< 130 mumol/L]) was the only characteristic identified as an indicator of clinical success (P < .05). Eleven patients (22%) required shunt revision during follow-up to gain or prolong control of symptoms. Cumulative survival in the population evaluated for clinical efficacy was 53% at 6 months and 48% at 1 year. A complete response was the only variable that indicated increased survival (P < .05; R2 = 12%) with a 6-month survival rate of 76% and a 1-year rate of 71%.


CONCLUSIONS
TIPS placement appears to be effective as a primary treatment of patients with cirrhosis and severe ascites.
Crenshaw
W B
WB
Department of Radiological Sciences, Deaconess Hospital, Boston, Mass, USA.
Gordon
F D
FD
McEniff
N J
NJ
Perry
L J
LJ
Hartnell
G
G
Anastopoulos
H
H
Jenkins
R L
RL
Lewis
W D
WD
Wheeler
H G
HG
Clouse
M E
ME
D000328:Adult; D000368:Aged; D001201:Ascites / Q000209:etiology / Q000601:surgery*; D005260:Female; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008099:Liver / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery; D011170:Portasystemic Shunt, Surgical; D011183:Postoperative Complications; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome; D014654:Vascular Patency