Refractory ascites: midterm results of treatment with a transjugular intrahepatic portosystemic shunt

Radiology. 1997 Oct;205(1):173-80. doi: 10.1148/radiology.205.1.9314981.


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

Materials and 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.

Conclusion: 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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Ascites / etiology
  • Ascites / mortality
  • Ascites / surgery*
  • Child
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Portasystemic Shunt, Transjugular Intrahepatic* / adverse effects
  • Postoperative Care
  • Prospective Studies
  • Survival Rate