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Radiologically Placed Peritoneovenous Shunt is an Acceptable Treatment Alternative for Refractory Ascites Due to End-Stage Liver Disease
- Source :
- Journal of vascular and interventional radiology : JVIR. 32(11)
- Publication Year :
- 2020
-
Abstract
- PURPOSE To compare patients treated with large-volume paracentesis (LVP), transjugular intrahepatic portosystemic shunt (TIPS), and peritoneovenous shunt (PVS) for ascites. MATERIALS AND METHODS A retrospective study of 192 patients treated with LVP (94), TIPS (75), or PVS (23) was performed. Records were reviewed for patient characteristics and outcomes. The patients' age differed (LVP, 59.5 years; TIPS, 58.8 years; and PVS, 65.6 years; P = .003). Nonalcoholic steatohepatitis was the most common etiology in the PVS cohort (11/23, 47%), and hepatitis C in the TIPS (27/75, 36%), and LVP cohorts (43/94, 46%) (P = .032). The model for end-stage liver disease score was significantly different (LVP, 14; TIPS, 13; and PVS, 8; P = .035). Hepatocellular carcinoma was higher in the PVS cohort (6/23 patients, 25%) than in the TIPS (4/75, 5%), and LVP (12/94, 12%) cohorts (P = .03). RESULTS Emergency department visits and hospital readmissions were the highest in the LVP cohort (40%, ≥2 readmissions, P < .001). Patients required fewer LVPs after TIPS (1.5 to 0.14, P < .001) or PVS (2.1 to 0.5, P = .019). In an unadjusted Cox model, patients in the TIPS cohort were found to have a 58% reduction in the risk of death compared with patients in the LVP cohort (P = .003). Transplant-free survival (PVS, 44 days; TIPS, 155 days; and LVP, 213 days) differed (log rank = 0.001). CONCLUSIONS The survival in the PVS and TIPS cohorts was similar, with less healthcare utilization than the LVP cohort. PVS is a satisfactory alternative to LVP.
- Subjects :
- Liver Cirrhosis
Peritoneovenous Shunt
endocrine system
medicine.medical_specialty
medicine.medical_treatment
Severity of Illness Index
End Stage Liver Disease
Liver disease
Ascites
medicine
Paracentesis
Humans
Radiology, Nuclear Medicine and imaging
Retrospective Studies
medicine.diagnostic_test
business.industry
Retrospective cohort study
Hepatitis C
Middle Aged
medicine.disease
Surgery
Peritoneovenous shunt
Treatment Outcome
Cohort
cardiovascular system
medicine.symptom
Portasystemic Shunt, Transjugular Intrahepatic
Cardiology and Cardiovascular Medicine
business
Transjugular intrahepatic portosystemic shunt
Subjects
Details
- ISSN :
- 15357732
- Volume :
- 32
- Issue :
- 11
- Database :
- OpenAIRE
- Journal :
- Journal of vascular and interventional radiology : JVIR
- Accession number :
- edsair.doi.dedup.....2da01e43a80987e4400221282d43d667