Transjugular Intrahepatic Portal Systemic Shunt for the Management of Symptomatic Cirrhotic Hydrothorax

Robert M. Strauss, Louis G. Martin, Stephen L. Kaufman, Thomas D. Boyer

Research output: Contribution to journalArticle

122 Scopus citations

Abstract

Objective: To investigate the safety and effectiveness of performing transjugular intrahepatic portal systemic shunt (TIPS) for the management of symptomatic cirrhotic hydrothorax in patients with advanced cirrhosis. Methods: TIPS was performed by standard technique after portal vein patency had been established by ultrasound. Portal‐hepatic vein pressure gradient was determined before and after placement of the shunt. A portal‐hepatic vein gradient of less than 12 mm Hg was the treatment goal. Results: Five patients underwent TIPS placement over an 11‐month period. Despite use of diuretics, the patients had required a median of seven thoracenteses (range 2–11) for control of symptoms preceding placement of the shunt. A TIPS was placed without serious complications in all live patients. In two patients, insertion of the shunt was associated with no further need for thoracentesis. The other three patients had recurrent need for thoracentesis. These three patients were found to have occluded shunts which were rendered patent by angiopiasty and/or urokinase. Subsequently, two required no further thoracentesis, whereas, in the other patient, the need for thoracentesis was decreased dramatically. Conclusions: TIPS appears to be a safe and useful technique for the management of patients with symptomatic cirrhotic hydrothorax that is refractory to medical therapy. Recurrence of the pleural effusion after placement of TIPS may be an indication of shunt occlusion.

Original languageEnglish (US)
Pages (from-to)1520-1522
Number of pages3
JournalThe American Journal of Gastroenterology
Volume89
Issue number9
DOIs
StatePublished - Sep 1994

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ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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