Abstract
Patients with advanced malignant tumor frequently develop refractory ascites caused by peritoneal carcinomatosis, multiple liver metastasis, obstruction of portal vein (PV) or inferior vena cava (IVC)/hepatic vein (HV) and that causes uncomfortable symptoms such as abdominal distention and appetite loss. Palliative interventional radiology (IR) techniques such as paracentesis, cell-free and concentrated ascites reinfusion therapy (CART), peritoneovenous shunt (PVS), PV stenting and IVC/HV stenting can provide improvement of these symptoms. To make optimal use of IR for ascites, indications should be decided based on physical examination, expected prognosis, speed of ascites re-accumulation, cytology of ascites, serum-ascites albumin gradient and radiological findings. Paracentesis and CART can provide palliation without serious adverse events and CART can also prevent protein loss, although, the efficacy is temporary. PVS is one of the aggressive treatment options to obtain continuous palliation; however, PVS placement can cause some fatal acute adverse events (e.g. heart failure, 3-12% and disseminated intravascular coagulation, 2-5%). Therefore, appropriate selection of patient and close postoperative management are mandatory for PVS placement. Vascular stenting is effective IR for patients with ascites resulting from obstruction of PV or IVC/HC; however, care should be taken for comorbid peritoneal carcinomatosis, which may contraindicate IR.
