title: Transjugular intrahepatic portosystemic shunt for the treatment of medically refractory ascites.
abstract: OBJECTIVE
  This study was performed to assess the safety, efficacy, and clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) creation for treatment of medically refractory ascites and to identify prognostic factors for clinical response, morbidity, and mortality.
  
  
  METHODS
  In this retrospective study, 80 patients (male:female, 52:28; mean age, 56 years; mean Model for End-Stage Liver Disease [MELD] score, 15.1) who underwent elective TIPS creation for refractory ascites between 1999-2012 were studied. A medical record review was performed to identify data on demographics, liver disease, procedures, and outcome. The influence of these parameters on 30-day, 90-day, and one-year mortality was assessed using binary logistic regression. Overall survival was analyzed with Kaplan-Meier statistics.
  
  
  RESULTS
  TIPS was successfully created using covered (n=70) or bare metal (n=10) stents. Hemodynamic success was achieved in all cases. The mean final portosystemic pressure gradient (PSG) was 6.8 mmHg. Thirty-day complications included mild encephalopathy in 35% of patients. Clinical improvement in ascites occurred in 78% of patients, with complete resolution or a ≥50% decrease in 66% of patients. No predictors of response or optimal PSG threshold were identified. The 30-day, 90-day, and one-year mortality rates were 14%, 23%, and 33%, respectively. Patient age (P = 0.026) was associated with 30-day mortality, while final PSG was associated with 90-day (P = 0.020) and one year (P = 0.032) mortality. No predictors of overall survival were identified.
  
  
  CONCLUSIONS
  TIPS creation effectively treats medically refractory ascites with nearly 80% efficacy. The incidence of mild encephalopathy is nontrivial. Older age and final PSG are associated with mortality, and these factors should be considered in patient selection and procedure performance.
authors.affiliation: From the Department of Radiology (R.C.G. e-mail: rgaba@uic.edu), Interventional Radiology Section, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Parvinian
authors.forename: James T
authors.initials: JT
authors.lastname: Bui
authors.forename: M Grace
authors.initials: MG
authors.lastname: Knuttinen
authors.forename: Jeet
authors.initials: J
authors.lastname: Minocha
authors.forename: Ron C
authors.initials: RC
authors.lastname: Gaba
mesh_terms: D001201:Ascites / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012189:Retrospective Studies; D015996:Survival Rate