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TIPS for Refractory Ascites and Hepatic Hydrothorax

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Abstract

Purpose of Review

This review summarizes the pathophysiology of portal hypertension, outcome data through the years supporting the use of TIPS in refractory ascites (RA) and hepatic hydrothorax (HH), and considerations for ideal TIPS candidates.

Recent Findings

Advances in stent technology over the last three decades have dramatically improved both quality of life and survival for patients with RA and HH. Importantly, the advent of controlled-expansion, covered stents has reduced the incidence of post-TIPS hepatic encephalopathy (HE) and mortality rates.

Summary

Controlled-expansion covered stents are now the guideline-recommended device for patients undergoing TIPS. Prospective trials including these newer TIPS recipients are still needed to determine ideal stent diameter, effective intra-operative portosystemic gradient cutoffs, and utility of pharmacologic HE prophylaxis for the indications of RA and/or HH.

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Data Availability

The data supporting the findings of this review are available from the corresponding author, AR, upon reasonable request.

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Authors and Affiliations

  1. Department of Internal Medicine, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., Suite 2330, Chicago, IL, USA

    Anjana Rajan

  2. Department of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., Suite 1900, Chicago, IL, USA

    Justin Boike

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  1. Anjana Rajan
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  2. Justin Boike
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AR reviewed the literature and drafted the main manuscript text. AR and JB critically revised the manuscript.

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Correspondence to Anjana Rajan or Justin Boike.

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AR has no conflicts of interest. JB has received consulting fees and investigator-initiated grant funding from W.L. Gore and Associates, the manufacturer of TIPS endoprosthesis. W.L. Gore and Associates had no influence on the authoring of this article.

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Rajan, A., Boike, J. TIPS for Refractory Ascites and Hepatic Hydrothorax. Curr Hepatology Rep 23, 45–53 (2024). https://doi.org/10.1007/s11901-023-00625-4

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