Portal Venous Decompression for Treatment of Portal Hypertension-Related Refractory Chylous Ascites or Chylothorax

Abstract

This study investigated the effectiveness of portal interventions on refractory chylous ascites or chylothorax related to portal hypertension. After institutional review board approval, a single-center retrospective review identified 10 patients from 2011 to 2023 who underwent portal interventions (8 transjugular intrahepatic portosystemic shunt creation and 2 portal vein recanalization) for documented chylous ascites (n = 8) or chylothorax (n = 2). Procedural details, clinical data, and chylous fluid volumes were recorded. Descriptive statistics and paired t-testing were used. Technical success was 100% with a median reduction of portal pressure gradient by 7.5 mm Hg. In 5 patients (50%), the chylous ascites or chylothorax resolved within 30 days of the intervention. All patients (n = 10) had decreased weekly fluid volume production after intervention (64% mean reduction, P < .001). Median time to last paracentesis or thoracentesis was 54 days. No moderate or severe adverse events occurred. In the setting of refractory chylous ascites or chylothorax associated with portal hypertension, decompressive portal interventions are safe and clinically effective.