Safety and Efficacy of Transjugular Intrahepatic Portosystemic Shunt Creation for the Treatment of Hepatic Hydrothorax

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PURPOSE

To evaluate safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) creation for hepatic hydrothorax (HHyd).

MATERIALS AND METHODS

Twenty-one patients underwent TIPS creation for HHyd. A prospective TIPS database and medical records were reviewed. Clinical and radiographic outcomes were recorded as complete (symptom/effusion resolution), partial (improved symptoms/effusion), or none. Data patterns were examined with χ2 tests and Kaplan-Meier analysis.

RESULTS

Patients included 12 women and nine men, with a mean age of 56 years, all with Child class B (n = 7) or C(n = 14) disease. The technical success rate was 100%. Mean follow-up was 223 days. Twenty-nine percent (six of 21) died within 30 days of TIPS creation, 10% (two of 21) underwent transplantation within 30 days, and 62% (13 of 21) survived beyond 30 days. Data were incomplete in two patients. Clinical response was classified as complete in 63% (12 of 19), partial in 11% (two of 19), and none in 26% (five of 19). Radiographic response was classified as complete in 30% (six of 20), partial in 50% (10 of 20), and none in 20% (four of 20). Nonresponders had multisystem organ failure, and all but one died within 30 days. However, of the 13 patients surviving longer than 30 days, 10 (77%) had a complete clinical response.

CONCLUSION

TIPS is a relatively safe and effective method of controlling HHyd. The majority of patients experienced improvement or resolution of clinical symptoms with a variable reduction in the quantity of pleural fluid. There was a tendency among nonresponders to die within 30 days.

Section snippets

Patient Population

From June 1995 through August 2000, 203 patients underwent TIPS creation. Of these, 12 patients presented with symptomatic hepatic hydrothorax as the primary indication for shunt creation. An additional nine TIPS procedures were performed for hepatic hydrothorax as a secondary indication (primary indications: intractable ascites, n = 7, and gastric varices/contraindication to sclerotherapy, n = 2). Analysis of patients with HHyd as either a primary or secondary indication demonstrated no

Clinical Characteristics

Among patients with HHyd, there were 12 women and nine men (compared to 60 women and 122 men in the general TIPS database). The increased number of women in the HHyd group was statistically significant (P = .03). The mean patient age was 56 years (range, 37–74 y). Cirrhotic liver disease was induced by a variety of factors including alcohol (n = 5), viral hepatitis (n = 6), both alcohol and hepatitis (n = 2), Budd-Chiari syndrome (n = 1), veno-occlusive disease (n = 1), primary biliary

DISCUSSION

HHyd is an uncommon and potentially lethal complication of portal hypertension in patients with cirrhosis. It is generally believed that HHyd results from the accumulation of ascitic fluid in the pleural space after passing through small rents in the diaphragm. The effusion usually occurs in the right hemithorax in the presence of ascites, although in some cases, there is no demonstrable ascites and/or effusions are bilateral. A diagnosis of HHyd is made in patients with cirrhosis either

SUMMARY

TIPS creation is a relatively safe and effective method of treating portal hypertension and controlling respiratory symptoms from HHyd in patients with cirrhosis and end-stage liver disease. TIPS creation was successful in 100% of patients in this study. Respiratory symptoms were controlled or eliminated in 74% of patients. Resolution or improvement of respiratory symptoms occurred often despite only partial radiographic resolution of effusions. In fact, complete lack of effusion on chest

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