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TIPS Versus Peritoneovenous Shunt in the Treatment of Medically Intractable Ascites: A Prospective Randomized Trial

Rosemurgy, Alexander S. MD*; Zervos, Emmanuel E. MD*; Clark, Whalen C. BS*; Thometz, Donald P. BA*; Black, Thomas J. MD; Zwiebel, Bruce R. MD; Kudryk, Bruce T. MD; Grundy, L Shane MD; Carey, Larry C. MD*

doi: 10.1097/01.sla.0000128309.36393.71
Original Articles and Discussions of the Southern Surgical Association
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Objective: We 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.

Methods: Thirty-two patients were prospectively randomized to undergo TIPS or peritoneovenous (Denver) shunts. All patients had failed medical therapy.

Results: After 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).

Conclusion: TIPS 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.

This prospective randomized clinical trial compares TIPS to peritoneovenous shunts (PV) in the treatment of medically intractable ascites. Thirty-two patients underwent TIPS or PV shunts. After either shunt, numerous interventions were required to assist patency. Absence of ascites was uncommon after either shunt. PV shunts control ascites sooner, although TIPS provides better long-term efficacy.

From the Departments of *Surgery and †Radiology, University of South Florida, Tampa, Florida.

Reprints: Alexander S. Rosemurgy, MD, University of South Florida, Tampa General Hospital, Box 1289, Room F-145, Tampa, FL 33606. E-mail: arosemur@hsc.usf.edu.

© 2004 Lippincott Williams & Wilkins, Inc.