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

Gwen K. Nazarian, Haraldur Bjarnason, Charles A Dietz, Casandra A. Bernadas, Mary C. Foshager, Hector Ferral, David W. Hunter

Research output: Contribution to journalArticlepeer-review

80 Scopus citations


PURPOSE: To assess midterm results and examine factors associated with successful treatment of refractory ascites with creation of a trans-jugular intrahepatic portosystemic shunt (TIPS). MATERIALS AND METHODS: In 80 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 μmol/L) and creatinine level greater than 1.9 mg/dL (170 μmol/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.

Original languageEnglish (US)
Pages (from-to)173-180
Number of pages8
Issue number1
StatePublished - Oct 1997


  • Ascites
  • Interventional procedures
  • Liver, cirrhosis
  • Liver, interventional procedure
  • Shunts, portosystemic


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