SIR 2024
Portal Hypertension
Ece Meram, MD
Resident Doctor
University of Wisconsin-Madison
Financial relationships: Full list of relationships is listed on the CME information page.
Orhan Ozkan, MD
Chief, Vascular and Interventional Radiology
UW Hospital & Clinics
Disclosure information not submitted.
Eric Monroe, MD (he/him/his)
Associate Professor
University of Wisconsin
Financial relationships: Full list of relationships is listed on the CME information page.
John F. Swietlik, MD
Assistant Professor
University of Wisconsin
Disclosure information not submitted.
An IRB-approved single-center retrospective review identified patients from 2011 to 2022 who underwent portal interventions, including TIPS and portal angioplasty/stenting. Ten patients were identified who underwent a portal intervention for documented chylous ascites (n=8) or chylothorax (n=2) by fluid analysis. Median triglyceride level in body fluids was 155 mg/dL. Portal interventions included TIPS placement in 8 patients (2 of which with thrombectomy), and portal vein angioplasty and stenting in 2 patients. Technical success, procedural details, adverse events, and clinical success were recorded. Descriptive statistics and paired t-tests were used for analysis.
Results: The technical success of portal interventions was 100%. The initial mean portal pressure gradient was 15 mmHg. Post-intervention mean portal pressure gradient was 7.1 mmHg, with a mean decrease of 7.9 mmHg. All patients (10/10) had decreased chylous fluid volume post-intervention with approximately 64% reduction in mean centesis volume (p=0.001). In 5 patients (50%), complete resolution of the chylous fluid was achieved within 30 days of the intervention. The median time to last fluid removal (i.e. paracentesis or thoracentesis) after portal intervention was 54 days. No moderate or severe procedural adverse events occurred. Five out of 8 patients developed medically manageable hepatic encephalopathy following TIPS placement.
Conclusion:
In the setting of refractory chylous ascites or chylothorax associated with elevated portal venous pressures, decompressive portal interventions are safe and clinically effective.