The Role of Transjugular Portosystemic Shunting in Patients with Ascites

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Abstract
Ascites is one of the most important complications of cirrhosis. It predisposes patients to several additional complications, including spontaneous bacterial peritonitis, the hepatorenal syndrome, and hepatic hydrothorax, and it is one of the most common indications for liver transplantation. Ascites is typically managed initially with diuretics and restriction of sodium intake. When this approach fails, the alternatives have been less than ideal. A number of therapies have been tried, including peritoneovenous shunts and side-to-side portocaval shunts, both of which are associated with an unacceptable incidence of severe adverse effects, such as disabling hepatic encephalopathy. More recently, large-volume paracentesis, the transjugular . . .