Refractory ascites: early experience in treatment with transjugular intrahepatic portosystemic shunt.

Ferral, Héctor; Bjarnason, Haraldur; Wegryn, Scott A.; Rengel, Gail J.; Nazarian, Gwen K.; Rank, Jeffrey M.; Tadavarthy, S. Murthy; Hunter, David W.; Castañeda-Zúñiga, Wilfrido R.

doi:10.1148/radiology.189.3.8234706

Cited by 104 publications

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“…ascitic fluid accumulation in the pleural space and therefore caused by portal hypertension, TIPS should effectively conThere were six deaths; one patient died of postprocedure sepsis after 7 days and two patients died of sepsis unrelated to trol hepatic hydrothorax. Our group 10 and others 11,12 have reported the successful use of TIPS to control refractory asci-TIPS. There was one death each caused by respiratory failure, liver failure, and hepatocellular carcinoma.…”

Section: Resultsmentioning

confidence: 84%

“…14 This treatment has been associated with several major com-experience of others. 11,21,22 Encephalopathy was the primary complication but was controlled with conservative medical plications including pain, a prolonged intensive care unit stay, 9 and the inability to remove the required chest tube management in each case. In summary, hepatic hydrothorax is an uncommon condibecause of reaccumulation of fluid.…”

Section: Resultsmentioning

confidence: 99%

“…The aim of this study was duces portal pressure and has been reported to improve the to determine the efficacy of TIPS in the treatment of control of refractory ascites in cirrhotic patients. [10][11][12] The goal symptomatic refractory hepatic hydrothorax. A TIPS was placed in 24 consecutive cirrhotic patients with of this study was to determine if the reduction in portal pressymptomatic refractory hepatic hydrothorax.…”

Section: Management Of Hepatic Hydrothorax Is Difficult and Oftenmentioning

confidence: 99%

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The successful treatment of symptomatic, refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt

Gordon¹,

Anastopoulos²,

Crenshaw³

et al. 1997

Hepatology

199

103

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Management of hepatic hydrothorax is difficult and oftenHepatic hydrothorax is a rare complication of portal results in iatrogenic complications. Repeated thoracentesis, hypertension. Conservative therapy may be successful chest tube thoracostomy, pleurodesis, and peritoneovenous but refractory hepatic hydrothorax is not uncommon.shunt have been used with varying degrees of success. HowManagement of refractory hydrothorax is usually inefever, there have been many reports of failure and complicafective and can result in a worsened clinical status.tion with each of these procedures. [7][8][9] The only definitive Transjugular intrahepatic portosystemic shunts (TIPS) treatment is liver transplantation. lower portal pressure and have been used in the treatTransjugular intrahepatic portosystemic shunt (TIPS) rement of refractory ascites. The aim of this study was duces portal pressure and has been reported to improve the to determine the efficacy of TIPS in the treatment of control of refractory ascites in cirrhotic patients. [10][11][12] The goal symptomatic refractory hepatic hydrothorax. A TIPS was placed in 24 consecutive cirrhotic patients with of this study was to determine if the reduction in portal pressymptomatic refractory hepatic hydrothorax. Five pa-sure by TIPS improved the control of symptomatic hepatic tients (20.8%) were Child's/Pugh class B and 19 (79.2%) hydrothorax. Additionally, we evaluated the effect of TIPS in were class C. All had undergone multiple thoracenteses these patients on the Child's-Pugh class and the need for and were hypoalbuminemic. Mean follow-up was 7.2 orthotopic liver transplantation. The Child's-Pugh score improved in 7 (58.3%) of these 12candidates. All acceptable alcoholic liver transplantation candidates patients and two patients improved from class C to class were considered to have been abstinent for at least 6 months. A. These two patients no longer require liver transAll patients had clinical, laboratory, and radiologic evidence of plantation. This study shows that TIPS can be effective liver disease and portal hypertension. All patients had persistent in the management of symptomatic, refractory hepatic right-sided hydrothorax despite sodium and fluid restriction and the hydrothorax. Clinical and laboratory improvement may use of the maximum tolerable doses of diuretics. Diuretic use was be seen and liver transplantation may become unneces-limited by progressive azotemia, electrolyte imbalance, and hypotension. Infectious causes of hydrothorax were ruled out by fluid analysary. (HEPATOLOGY 1997;25:1366-1369.) sis and culture. Only patients with pulmonary symptoms, such as dyspnea and orthopnea, were enrolled in the study. All patients had Hepatic hydrothorax is the accumulation of ascitic fluid undergone multiple thoracenteses before transfer to our hospital. in the pleural space. It occurs in 0.4% to 12.2% of cirrhotic Five patients had chest tubes in place draining at least 4 L/d. Atpatients.1-3 The precise pathogenetic mechanisms remain un-tempts to remove or clamp ...

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Section: Resultsmentioning

confidence: 84%

Section: Resultsmentioning

confidence: 99%

Section: Management Of Hepatic Hydrothorax Is Difficult and Oftenmentioning

confidence: 99%

See 1 more Smart Citation

The successful treatment of symptomatic, refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt

Gordon¹,

Anastopoulos²,

Crenshaw³

et al. 1997

Hepatology

199

103

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“…[10][11][12][13][14] A number of studies have also shown that the reduction in portal pressure induced by TIPS is associated with beneficial effects on renal function and neurohumoral factors in patients with cirrhosis and ascites, including an increase in sodium and water excretion and a reduction in the activity of vasoconstrictor and antinatriuretic systems. [15][16][17][18][19][20][21][22] By contrast, the effects of TIPS in patients with HRS are not well characterized. Several case reports and preliminary data suggest that TIPS may improve renal function in cirrhotic patients with HRS.…”

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confidence: 99%

Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: Effects on renal function and vasoactive systems

Guevara¹,

Ginès²,

Bandi³

et al. 1998

Hepatology

387

202

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Little information exists on the effects of transjugular intrahepatic portosystemic shunts (TIPS) in the management of cirrhotic patients with hepatorenal syndrome (HRS). The current study was aimed to prospectively evaluate the effects of TIPS on renal function and vasoactive systems in patients with type I HRS. Glomerular filtration rate (GFR) (inulin clearance), renal plasma flow (RPF) (para-aminohippurate clearance), plasma renin activity (PRA), aldosterone (ALDO), norepinephrine (NE), and endothelin (ET) were determined in baseline conditions and at different time intervals after TIPS in 7 patients with type I HRS. TIPS induced a marked reduction of portal pressure gradient (PPG) (20 ؎ 1 to 10 ؎ 1 mm Hg; P F .05). Renal function improved in 6 of the 7 patients. Serum creatinine and blood urea nitrogen (BUN) decreased from 5 ؎ 0.8 and 109 ؎ 7 to 1.8 ؎ 0.4 mg/dL and 56 ؎ 11 mg/dL, respectively (P F .05 for both), and GFR and RPF increased from 9 ؎ 4 and 103 ؎ 33 to 27 ؎ 7 mL/min and 233 ؎ 40 mL/min, respectively (P F .05 for both), 30 days after TIPS. These beneficial effects on renal function were associated with a significant (P F .05) reduction of PRA (18 ؎ 5 to 3 ؎ 1 ng/mL · h), ALDO (279 ؎ 58 to 99 ؎ 56 ng/dL), and NE (1,257 ؎ 187 to 612 ؎ 197 pg/mL). ET did not change significantly (28 ؎ 8 to 27 ؎ 11 pg/mL). Mean survival was 4.7 ؎ 2 months (0.3-17 months). Three patients remained alive more than 3 months after TIPS insertion. In conclusion, TIPS improves renal function and reduces the activity of the renin-angiotensin and sympathetic nervous systems in cirrhotic patients with type I HRS. Nevertheless, the efficacy of TIPS in the management of these patients should be confirmed in controlled investigations. (HEPATOLOGY 1998;28:416-422.)Hepatorenal syndrome (HRS) is a common and severe complication of patients with advanced cirrhosis and is characterized by renal failure, marked portal hypertension, abnormalities in the arterial circulation, and overactivity of endogenous vasoactive systems. [1][2][3][4][5] Up to now, the only treatment that has been shown to improve survival in patients with HRS is liver transplantation. 3-7 However, because of the short survival of patients with HRS and the limited availability of organs, only a small percentage of patients with HRS can actually reach transplantation. Therefore, it would be of great value to have a therapeutic method that could improve renal function and increase survival, especially in patients with type I HRS, which is characterized by a rapid progression of renal failure and a very short survival expectancy. 3 The transjugular intrahepatic portosystemic shunt (TIPS) has been introduced recently in clinical practice for the management of cirrhotic patients with variceal bleeding. 8,9 As with surgical portosystemic shunts, the use of TIPS is associated with a marked reduction in portal pressure but with the advantage of a very low operative morbidity and mortality. It has been shown that TIPS is useful in the management of acute variceal hemorrhage th...

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Refractory ascites is defined as ascites that cannot beTo date, there are 12 published papers reporting the results of 11 uncontrolled and 1 randomized controlled mobilized, or the early recurrence of which cannot be prevented despite maximal diuretic therapy of 400 mg of studies which assessed the efficacy of TIPS as a treatment for refractory ascites [9][10][11][12][13][14][15][16][17][18][19][20]. The only randomized conspironolactone or 30 mg of amiloride plus up to 120 mg of furosemide daily for at least 1 week despite being on trolled studies compared TIPS versus large volume paracentesis [15].

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confidence: 99%

Transjugular Intrahepatic Portosystemic Stent Shunt for Hepatorenal Syndrome and Ascites

Wong¹

1998

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Refractory ascites is defined as ascites that cannot be mobilized, or the early recurrence of which cannot be prevented despite maximal diuretic therapy of 400 mg of spironolactone or 30 mg of amiloride plus up to 120 mg of furosemide daily for at least 1 week despite being on dietary sodium restriction of 50 mEq or less per day. Patients who cannot tolerate diuretic therapy because of complications are also regarded as having refractory ascites [1]. Approximately 5% of all patients with ascites are refractory to conventional medical therapy of sodium restriction, diuretics and large volume paracentesis, and the management of these patients has been unsatisfactory. The recent development of a transjugular intrahepatic portosystemic stent shunt (TIPS) as a treatment for refractory variceal hemorrhage [2–4] led to the observation that after TIPS placement, concomitant ascites in these patients seemed to disappear or became easier to control [5–7]. There followed a flurry of enthusiasm on the use of TIPS as a treatment for refractory ascites.

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Refractory ascites: early experience in treatment with transjugular intrahepatic portosystemic shunt.

Abstract: 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.

Cited by 104 publications

References 0 publications

The successful treatment of symptomatic, refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt

The successful treatment of symptomatic, refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt

Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: Effects on renal function and vasoactive systems

Transjugular Intrahepatic Portosystemic Stent Shunt for Hepatorenal Syndrome and Ascites

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