Semin intervent Radiol 2005; 22(4): 278-286
DOI: 10.1055/s-2005-925554
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Transjugular Intrahepatic Portosystemic Shunt in the Management of Refractory Ascites

Guadalupe Garcia-Tsao1
  • 1Professor of Medicine, Yale University School of Medicine, and VA-CT Healthcare System, New Haven, Connecticut
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Publikationsverlauf

Publikationsdatum:
03. Januar 2006 (online)

ABSTRACT

The purpose of this article is to describe the pathophysiological basis for the use of transjugular intrahepatic portosystemic shunt (TIPS) in patients with cirrhosis and refractory ascites, the short- and long-term hemodynamic, biochemical, and hormonal changes after TIPS, and the results of controlled trials of TIPS in cirrhotic patients with refractory ascites. TIPS placement is associated with normalization of sinusoidal pressure and a significant improvement in urinary sodium excretion that correlates with suppression of plasma renin activity (indicative of an improvement in effective arterial blood volume). Although effective in preventing the recurrence of ascites, the efficacy of TIPS is offset by an increase in the incidence of severe hepatic encephalopathy, a high incidence of shunt dysfunction, and a higher cost without an overall survival benefit, which should be reevaluated in light of polytetrafluoroethylene-covered stents. TIPS placement is currently indicated in seleceted cirrhotic patients with refractory ascites who require more than two to three large-volume paracenteses per month.

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Guadalupe Garcia-TsaoM.D. 

Section of Digestive Diseases, Yale University School of Medicine

One Gilbert Street, TAC, Room #S241B, New Haven, CT 06510