title: Severe ascites: efficacy of the transjugular intrahepatic portosystemic shunt in treatment.
abstract: 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.
authors.affiliation: Department of Radiological Sciences, Deaconess Hospital, Boston, Mass, USA.
authors.forename: W B
authors.initials: WB
authors.lastname: Crenshaw
authors.forename: F D
authors.initials: FD
authors.lastname: Gordon
authors.forename: N J
authors.initials: NJ
authors.lastname: McEniff
authors.forename: L J
authors.initials: LJ
authors.lastname: Perry
authors.forename: G
authors.initials: G
authors.lastname: Hartnell
authors.forename: H
authors.initials: H
authors.lastname: Anastopoulos
authors.forename: R L
authors.initials: RL
authors.lastname: Jenkins
authors.forename: W D
authors.initials: WD
authors.lastname: Lewis
authors.forename: H G
authors.initials: HG
authors.lastname: Wheeler
authors.forename: M E
authors.initials: ME
authors.lastname: Clouse
mesh_terms: 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