Treatment of refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt: long-term results in 40 patients

Siegerstetter, V.; Deibert, Peter; Ochs, Andreas; Olschewski, Manfred; Blum, Hubert E.; Rössle, Martin

doi:10.1097/00042737-200105000-00011

Cited by 173 publications

(115 citation statements)

References 17 publications

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“…Transjugular intrahepatic portosystemic shunt improved untreatable refractory hydrothorax in more than 80% of these cases and facilitated the complete removal of pleural effusion in 60–70% of patients. In addition, the TIPS procedure provided symptomatic relief in 70–80% of patients with refractory hydrothorax 3, 6. However, there have been several reports of worsening hepatic encephalopathy (HE) after the TIPS procedure in 30–46% of cases and intrahepatic shunt insufficiency in 15–25% 2, 3, 4, 5, 6.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the TIPS procedure provided symptomatic relief in 70–80% of patients with refractory hydrothorax 3, 6. However, there have been several reports of worsening hepatic encephalopathy (HE) after the TIPS procedure in 30–46% of cases and intrahepatic shunt insufficiency in 15–25% 2, 3, 4, 5, 6. The deterioration of hepatic function, hepatorenal syndrome, intraperitoneal hemorrhage, or hemobilia may also occur in rare cases 2, 3, 4, 5, 6.…”

Section: Discussionmentioning

confidence: 99%

“…However, there have been several reports of worsening hepatic encephalopathy (HE) after the TIPS procedure in 30–46% of cases and intrahepatic shunt insufficiency in 15–25% 2, 3, 4, 5, 6. The deterioration of hepatic function, hepatorenal syndrome, intraperitoneal hemorrhage, or hemobilia may also occur in rare cases 2, 3, 4, 5, 6. The approximate survival rates of patients who underwent the TIPS procedure were as follows: 3 months, 80%; 6 months, 75%; 1 year, 40–60%; 3 years, 25%; and 5 years, 15% 2, 6, 7…”

Section: Discussionmentioning

confidence: 99%

“…The deterioration of hepatic function, hepatorenal syndrome, intraperitoneal hemorrhage, or hemobilia may also occur in rare cases 2, 3, 4, 5, 6. The approximate survival rates of patients who underwent the TIPS procedure were as follows: 3 months, 80%; 6 months, 75%; 1 year, 40–60%; 3 years, 25%; and 5 years, 15% 2, 6, 7…”

Section: Discussionmentioning

confidence: 99%

“…Namely, the Child–Pugh score (>12), Model of End‐stage Liver Disease (MELD) score (>22), and serum bilirubin level (>3 mg/dL) have been proposed as predictors of a bad prognosis 3, 4, 5. When patients are younger than 60 years old and their pre‐TIPS MELD score is <15 points, symptomatic recovery is estimated to be better 3, 6, 7. Our patient was 64 years old (>60 years), his Child–Pugh score was 13 (>12), and his MELD score was 21 (>15).…”

Section: Discussionmentioning

confidence: 99%

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Direct intrahepatic portocaval shunt for refractory hepatic hydrothorax: a case report

Kawahara

Tanaka

Isoi

et al. 2016

Acute Medicine & Surgery

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CaseA 64‐year‐old man with complaints of dyspnea and orthopnea secondary to a hepatic hydrothorax refractory to diuretic medication underwent the transjugular intrahepatic portosystemic shunt (TIPS) procedure to decrease the portal vein pressure. The TIPS procedure failed due to severe liver stiffness. Direct intrahepatic portocaval shunt (DIPS), a modified TIPS procedure that directly inserts a stent from the inferior vena cava to the portal vein, was successfully carried out.OutcomeThe DIPS procedure significantly decreased the patient's pleural effusion and respiratory symptoms.ConclusionNo other medical treatment is available to control refractory pleural effusion caused by portal hypertension; however, the TIPS (or DIPS) procedure can be successfully carried out in patients <60 years old with a Model of End‐Stage Liver Disease score <15.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Direct intrahepatic portocaval shunt for refractory hepatic hydrothorax: a case report

Kawahara

Tanaka

Isoi

et al. 2016

Acute Medicine & Surgery

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Indications for Use of TIPS in Treating Portal Hypertension

Verna

2008

AMA Journal of Ethics

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For more than 20 years, transjugular intrahepatic portosystemic shunts (TIPS) have been used to treat complications of portal hypertension and are now being introduced in an expanding number of clinical settings. The TIPS procedure involves the angiographically guided creation of a connection between the hepatic vein and the intrahepatic portal vein that allows blood to flow from the portal vein to the inferior vena cava and back to systemic circulation with little resistance. The shunt, generally put in place by interventional radiologists, is kept open by the deployment of a metal stent across the tract. The procedure and evidence for its use in specific manifestations of portal hypertension were reviewed in detail in the American Association for the Study of Liver Diseases (AASLD) guidelines [1]. Accepted indications for TIPS are:• Gastrointestinal BleedingPortal hypertension may lead to gastrointestinal bleeding from a variety of lesions, including varices of the esophagus, stomach, small or large intestine, portal hypertensive gastropathy (PHG), and gastric antral vascular ectasia (GAVE). The role of TIPS in the treatment and prevention of these lesions has not been fully studied in most cases, but about one-third of deaths from cirrhosis are due to gastrointestinal bleeding. TIPS procedures are best studied in this patient population and have been shown to eradicate esophageal varices effectively. The shunts are successful in the treatment of esophageal variceal bleeding that is refractory to firstline endoscopic and pharmacologic therapy, especially in patients who are poor

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Monitoring the Patient Awaiting Transplantation

Müllhaupt¹

2006

Medical Care of the Liver Transplant Patient

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Treatment of refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt: long-term results in 40 patients

Abstract: TIPS is effective for hydrothorax refractory to diuretic treatment and other standard interventions to bridge the time to transplantation. Patients older than 60 years have a poor response and short survival.

Cited by 173 publications

References 17 publications

Direct intrahepatic portocaval shunt for refractory hepatic hydrothorax: a case report

Direct intrahepatic portocaval shunt for refractory hepatic hydrothorax: a case report

Indications for Use of TIPS in Treating Portal Hypertension

Monitoring the Patient Awaiting Transplantation

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