Clinical and Procedural Management of Refractory Ascites

Introduction: Refractory ascites is defined as ascites unresponsive to medical therapy (restricted sodium diet and high-dose diuretic treatment) or with rapid recurrence after therapeutic paracentesis. Of cirrhotic patients with ascites, 10% of these patients go on to develop refractory ascites. Within this subset of patients, interventional radiology plays an integral role in improving the morbidity and possibly the mortality. This exhibit will discuss and compare the types of procedures involved in the management of refractory ascites.

Content Organization:

1. Discuss the background of refractory ascites (definition and mortality rates).

2. Pathophysiology of ascites.

3. Different interventional radiology treatment options: large-volume paracentesis, Pleurx catheter, peritoneovenous (Denver) shunt, and transjugular intrahepatic portosystemic shunt.

Learning Points: Interventional radiology plays a pivotal role in the morbidity and mortality of refractory ascites, whether it be serving as a bridge to liver transplantation or the palliation of terminally ill patients. The goal of this exhibit is to discuss the pros and cons of the different types of procedures offered in these patients.

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