Transjugular Intrahepatic Portosystemic Stent Shunt for Hepatorenal Syndrome and Ascites

Abstract

Refractory ascites is defined as ascites that cannot be mobilized, or the early recurrence of which cannot be prevented despite maximal diuretic therapy of 400 mg of spironolactone or 30 mg of amiloride plus up to 120 mg of furosemide daily for at least 1 week despite being on dietary sodium restriction of 50 mEq or less per day. Patients who cannot tolerate diuretic therapy because of complications are also regarded as having refractory ascites [1]. Approximately 5% of all patients with ascites are refractory to conventional medical therapy of sodium restriction, diuretics and large volume paracentesis, and the management of these patients has been unsatisfactory. The recent development of a transjugular intrahepatic portosystemic stent shunt (TIPS) as a treatment for refractory variceal hemorrhage [2–4] led to the observation that after TIPS placement, concomitant ascites in these patients seemed to disappear or became easier to control [5–7]. There followed a flurry of enthusiasm on the use of TIPS as a treatment for refractory ascites.