ERS3066. Efficacy of Portal Interventions for the Management of Refractory Chylous Ascites/Chylothorax
Authors * Denotes Presenting Author
  1. Ece Meram *; University of Wisconsin-Madison
  2. John Swietlik; University of Wisconsin-Madison
  3. Michael McKernan; University of Wisconsin-Madison School of Medicine and Public Health
  4. Michael Woods; University of Wisconsin-Madison
  5. Eric Monroe; University of Wisconsin-Madison
  6. Orhan Ozkan; University of Wisconsin-Madison
Chylous ascites/chylothorax remains a rare pathophysiology, accounting for < 1% of portal hypertension-associated ascites. When medical management and/or lymphangiogram fails, the role of endovascular decompressive intervention is unclear. Specifically, data regarding TIPS and portal venous recanalization is limited. This study aimed to investigate the efficacy of portal interventions on refractory chylous ascites/chylothorax.

Materials and Methods:
A single-center retrospective review identified patients from 2011-2022 who underwent portal interventions, including TIPS, portal stenting, or angioplasty. Eight patients were identified with documented chylous ascites/chylothorax by fluid analysis who underwent portal intervention. 7 patients had chylous ascites, while 1 patient had chylothorax with minimal ascites. Median triglyceride levels in body fluid were 163 mg/dL. Portal interventions included TIPS placement in 6 patients (2 TIPS patients also 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- testing were used for analysis of the data.

The technical success of portal interventions was 100%. Following the portal intervention, the median change in portal pressure gradient was -7.5 mmHg. In 4 patients (50%), the chylous ascites/chylothorax were found to resolve within 30 days of the intervention. All patients (8/8, 100%) had decreased fluid volume post-intervention with approximately 63% reduction in mean fluid volume (p=0.001). Median time to last fluid removal (paracentesis or thoracentesis) after the portal intervention was 106 days. No moderate or severe procedural adverse events occurred. Two patients developed medically manageable hepatic encephalopathy following TIPS placement.

In the setting of refractory chylous ascites/chylothorax associated with elevated portal system pressures, decompressive portal interventions are safe and clinically effective.