• Annals of surgery · Jun 2004

    Randomized Controlled Trial Comparative Study Clinical Trial

    TIPS versus peritoneovenous shunt in the treatment of medically intractable ascites: a prospective randomized trial.

    • Alexander S Rosemurgy, Emmanuel E Zervos, Whalen C Clark, Donald P Thometz, Thomas J Black, Bruce R Zwiebel, Bruce T Kudryk, L Shane Grundy, and Larry C Carey.
    • Department of Surgery, University of South Florida, Tampa, Florida, USA. arosemur@hsc.usf.edu
    • Ann. Surg. 2004 Jun 1; 239 (6): 883891883-9; discussion 889-91.

    ObjectiveWe undertook a prospective randomized clinical trial comparing TIPS to peritoneovenous (PV) shunts in the treatment of medically intractable ascites to establish relative efficacy and morbidity, and thereby superiority, between these shunts.MethodsThirty-two patients were prospectively randomized to undergo TIPS or peritoneovenous (Denver) shunts. All patients had failed medical therapy.ResultsAfter TIPS versus peritoneovenous shunts, median (mean +/- SD) duration of shunt patency was similar: 4.4 months (6 +/- 6.6 months) versus 4.0 months (5 +/- 4.6 months). Assisted shunt patency was longer after TIPS: 31.1 months (41 +/- 25.9 months) versus 13.1 months (19 +/- 17.3 months) (P < 0.01, Wilcoxon test). Ultimately, after TIPS 19% of patients had irreversible shunt occlusion versus 38% of patients after peritoneovenous shunts. Survival after TIPS was 28.7 months (41 +/- 28.7 months) versus 16.1 months (28 +/- 29.7 months) after peritoneovenous shunts. Control of ascites was achieved sooner after peritoneovenous shunts than after TIPS (73% vs. 46% after 1 month), but longer-term efficacy favored TIPS (eg, 85% vs. 40% at 3 years).ConclusionTIPS and peritoneovenous shunts treat medically intractable ascites. Absence of ascites after either is uncommon. PV shunts control ascites sooner, although TIPS provides better long-term efficacy. After either shunt, numerous interventions are required to assist patency. Assisted shunt patency is better after TIPS. Treating medically refractory ascites with TIPS risks early shunt-related mortality for prospects of longer survival with ascites control. This study promotes the application of TIPS for medically intractable ascites if patients undergoing TIPS have prospects beyond short-term survival.

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