Refractory ascites: midterm results of treatment with a transjugular intrahepatic portosystemic shunt.
OBJECTIVE
To assess midterm results and examine factors associated with successful treatment of refractory ascites with creation of a transjugular intrahepatic portosystemic shunt (TIPS).


METHODS
In 50 patients with refractory ascites, TIPS creation was performed. Clinical and ultrasound follow-up were performed. Success was defined as survival with no further therapeutic paracentesis and decreased ascites.


RESULTS
Mean follow-up was 11.6 months after the TIPS procedure. Major complications occurred in 16% of patients including intraperitoneal hemorrhage, refractory encephalopathy, and progression of liver and renal failure. Overall mortality was 60% (30 patients). In 23 (62%) of 37 patients not lost to follow-up, ascites was controlled successfully at 1-3 months. A bilirubin level greater than 3.0 mg/dL (52 mumol/L) and creatinine level greater than 1.9 mg/dL (170 mumol/L) were associated with treatment failure (86% treatment failure at 3 months) and early mortality (P = .03). In all 14 patients alive at 1-year follow-up, ascites was controlled successfully.


CONCLUSIONS
TIPS creation is often useful in treatment of severe ascites not controlled with medical therapy. In patients with advanced liver and renal failure, TIPS creation is not associated with a definite benefit and may hasten death.
Nazarian
G K
GK
Department of Radiology, University of Minnesota School of Medicine, Minneapolis 55455-0391, USA.
Bjarnason
H
H
Dietz
C A
CA
Bernadas
C A
CA
Foshager
M C
MC
Ferral
H
H
Hunter
D W
DW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects; D011182:Postoperative Care; D011446:Prospective Studies; D015996:Survival Rate