Severe ascites: efficacy of the transjugular intrahepatic portosystemic shunt in treatment

Radiology. 1996 Jul;200(1):185-92. doi: 10.1148/radiology.200.1.8657908.


Purpose: To evaluate the transjugular intrahepatic portosystemic shunt (TIPS) as primary treatment in patients with cirrhosis and severe ascites.

Materials and 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%.

Conclusion: TIPS placement appears to be effective as a primary treatment of patients with cirrhosis and severe ascites.

MeSH terms

  • Adult
  • Aged
  • Ascites / etiology
  • Ascites / surgery*
  • Female
  • Hepatic Veins / surgery
  • Humans
  • Kidney / physiopathology
  • Liver / physiopathology
  • Liver Cirrhosis / complications
  • Liver Transplantation
  • Male
  • Middle Aged
  • Portal Vein / surgery
  • Portasystemic Shunt, Surgical*
  • Postoperative Complications
  • Prospective Studies
  • Recurrence
  • Reoperation
  • Treatment Outcome
  • Vascular Patency