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Semin intervent Radiol 2014; 31(03): 276-278
DOI: 10.1055/s-0034-1382799
Clinical Corner
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Paracentesis-Induced Circulatory Dysfunction: A Primer for the Interventional Radiologist

Aaron J. Lindsay
1   Department of Radiology, University of Colorado, Aurora, Colorado
,
James Burton
2   Department of Gastroenterology, University of Colorado, Aurora, Colorado
,
Charles E. Ray Jr.
3   Department of Radiology, University of Illinois at Chicago, Chicago, Illinois
› Author Affiliations
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Publication History

Publication Date:
21 August 2014 (online)

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Abstract

Paracentesis-induced circulatory dysfunction is a complication of large volume paracentesis that leads to faster reaccumulation of ascites, hyponatremia, renal impairment, and shorter survival. Knowledge of the pathophysiology, clinical presentation, diagnosis, and prevention of this condition is vital to the interventional radiologist as a valued team member in the treatment of ascites.

Keywords

paracentesis - ascites - complication - circulatory dysfunction
 

  • References

  • 1 Ginès P, Cárdenas A, Arroyo V, Rodés J. Management of cirrhosis and ascites. N Engl J Med 2004; 350 (16) 1646-1654
    CrossrefPubMedGoogle Scholar
    • 2 Ginés P, Quintero E, Arroyo V , et al. Compensated cirrhosis: natural history and prognostic factors. Hepatology 1987; 7 (1) 122-128
      CrossrefPubMedGoogle Scholar
    • 3 Planas R, Montoliu S, Ballesté B , et al. Natural history of patients hospitalized for management of cirrhotic ascites. Clin Gastroenterol Hepatol 2006; 4 (11) 1385-1394
      CrossrefPubMedGoogle Scholar
    • 4 Hsu SJ, Huang HC. Management of ascites in patients with liver cirrhosis: recent evidence and controversies. J Chin Med Assoc 2013; 76 (3) 123-130
      CrossrefPubMedGoogle Scholar
    • 5 Kuiper JJ, de Man RA, van Buuren HR. Review article: Management of ascites and associated complications in patients with cirrhosis. Aliment Pharmacol Ther 2007; 26 (Suppl. 02) 183-193
      PubMedGoogle Scholar
    • 6 Ginès P, Titó L, Arroyo V , et al. Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis. Gastroenterology 1988; 94 (6) 1493-1502
      PubMedGoogle Scholar
    • 7 Saló J, Ginès A, Ginès P , et al. Effect of therapeutic paracentesis on plasma volume and transvascular escape rate of albumin in patients with cirrhosis. J Hepatol 1997; 27 (4) 645-653
      CrossrefPubMedGoogle Scholar
    • 8 Ruiz-del-Arbol L, Monescillo A, Jimenéz W, Garcia-Plaza A, Arroyo V, Rodés J. Paracentesis-induced circulatory dysfunction: mechanism and effect on hepatic hemodynamics in cirrhosis. Gastroenterology 1997; 113 (2) 579-586
      CrossrefPubMedGoogle Scholar
    • 9 Sola-Vera J, Such J. Understanding the mechanisms of paracentesis-induced crculatory dysfunction. Eur J Gastroenterol Hepatol 2004; 16 (3) 295-298
      PubMedGoogle Scholar
    • 10 Vila MC, Solà R, Molina L , et al. Hemodynamic changes in patients developing effective hypovolemia after total paracentesis. J Hepatol 1998; 28 (4) 639-645
      CrossrefPubMedGoogle Scholar
    • 11 Coll S, Vila MC, Molina L, Gimenez MD, Guarner C, Solà R. Mechanisms of early decrease in systemic vascular resistance after total paracentesis: influence of flow rate of ascites extraction. Eur J Gastroenterol Hepatol 2004; 16 (3) 347-353
      PubMedGoogle Scholar
    • 12 Pozzi M, Osculati G, Boari G , et al. Time course of circulatory and humoral effects of rapid total paracentesis in cirrhotic patients with tense, refractory ascites. Gastroenterology 1994; 106 (3) 709-719
      PubMedGoogle Scholar
    • 13 Cabrera J, Falcón L, Gorriz E , et al. Abdominal decompression plays a major role in early postparacentesis haemodynamic changes in cirrhotic patients with tense ascites. Gut 2001; 48 (3) 384-389
      CrossrefPubMedGoogle Scholar
    • 14 Ryan J, Sudhir K, Jennings G, Esler M, Dudley F. Impaired reactivity of the peripheral vasculature to pressor agents in alcoholic cirrhosis. Gastroenterology 1993; 105 (4) 1167-1172
      PubMedGoogle Scholar
    • 15 Bernardi M, Caraceni P, Navickis RJ, Wilkes MM. Albumin infusion in patients undergoing large-volume paracentesis: a meta-analysis of randomized trials. Hepatology 2012; 55 (4) 1172-1181
      CrossrefPubMedGoogle Scholar
    • 16 Ginès A, Fernández-Esparrach G, Monescillo A , et al. Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis. Gastroenterology 1996; 111 (4) 1002-1010
      CrossrefPubMedGoogle Scholar
    • 17 Cárdenas A, Ginès P, Runyon BA. Is albumin infusion necessary after large volume paracentesis?. Liver Int 2009; 29 (5) 636-640 , discussion 640–641
      PubMedGoogle Scholar
    • 18 Peltekian KM, Wong F, Liu PP, Logan AG, Sherman M, Blendis LM. Cardiovascular, renal, and neurohumoral responses to single large-volume paracentesis in patients with cirrhosis and diuretic-resistant ascites. Am J Gastroenterol 1997; 92 (3) 394-399
      PubMedGoogle Scholar
    • 19 Sola-Vera J, Miñana J, Ricart E , et al. Randomized trial comparing albumin and saline in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients with ascites. Hepatology 2003; 37 (5) 1147-1153
      CrossrefPubMedGoogle Scholar
    • 20 Kwok CS, Krupa L, Mahtani A , et al. Albumin reduces paracentesis-induced circulatory dysfunction and reduces death and renal impairment among patients with cirrhosis and infection: a systematic review and meta-analysis. Biomed Res Int 2013; 2013: 295153
      PubMedGoogle Scholar
    • 21 Alessandria C, Elia C, Mezzabotta L , et al. Prevention of paracentesis-induced circulatory dysfunction in cirrhosis: standard vs half albumin doses. A prospective, randomized, unblinded pilot study. Dig Liver Dis 2011; 43 (11) 881-886
      PubMedGoogle Scholar
    • 22 Moreau R, Asselah T, Condat B , et al. Comparison of the effect of terlipressin and albumin on arterial blood volume in patients with cirrhosis and tense ascites treated by paracentesis: a randomised pilot study. Gut 2002; 50 (1) 90-94
      CrossrefPubMedGoogle Scholar
    • 23 Singh V, Kumar R, Nain CK, Singh B, Sharma AK. Terlipressin versus albumin in paracentesis-induced circulatory dysfunction in cirrhosis: a randomized study. J Gastroenterol Hepatol 2006; 21 (1 Pt 2) 303-307
      CrossrefPubMedGoogle Scholar
    • 24 Fimiani B, Guardia DD, Puoti C , et al. The use of terlipressin in cirrhotic patients with refractory ascites and normal renal function: a multicentric study. Eur J Intern Med 2011; 22 (6) 587-590
      CrossrefPubMedGoogle Scholar
    • 25 Singh V, Dheerendra PC, Singh B , et al. Midodrine versus albumin in the prevention of paracentesis-induced circulatory dysfunction in cirrhotics: a randomized pilot study. Am J Gastroenterol 2008; 103 (6) 1399-1405
      CrossrefPubMedGoogle Scholar
    • 26 Wong F, Watson H, Gerbes A , et al; Satavaptan Investigators Group. Satavaptan for the management of ascites in cirrhosis: efficacy and safety across the spectrum of ascites severity. Gut 2012; 61 (1) 108-116
      CrossrefPubMedGoogle Scholar
    • 27 Ge PS, Runyon BA. The changing role of beta-blocker therapy in patients with cirrhosis. J Hepatol 2014; 60 (3) 643-653
      CrossrefPubMedGoogle Scholar
    • 28 Sersté T, Francoz C, Durand F , et al. Beta-blockers cause paracentesis-induced circulatory dysfunction in patients with cirrhosis and refractory ascites: a cross-over study. J Hepatol 2011; 55 (4) 794-799
      CrossrefPubMedGoogle Scholar
    • 29 Sersté T, Melot C, Francoz C , et al. Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites. Hepatology 2010; 52 (3) 1017-1022
      CrossrefPubMedGoogle Scholar