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