Based on the ability to induce vascular leakage and promote the accumulation of ascites, vascular endothelial growth factor (VEGF) -A is considered as a vascular permeability factor. VEGF-C and VEGF-D drive lymphangiogenesis, which can provide conduits for fluid to extravasate from leaky blood vessels. In order to evaluate whether these VEGF family members play a role in refractory ascites (RA), VEGF-A, VEGF-C, and VEGF-D levels were measured in the ascitic fluid of cirrhotic patients using enzyme-linked immunosorbent assay. We studied 24 cirrhotic patients; 12 had RA (group 1) and 12 had non-RA (group 2). Ascitic VEGF-A levels were significantly higher in group 1 than in group 2. Thus, the VEGF-A levels is useful in the discrimination between patients with and without RA. Moreover, a significant correlation was observed between ascitic fluid VEGF-C levels and urinary sodium excretions, a predictor of RA. These results suggest that ascitic VEGF-A levels may be helpful in the diagnosis of RA in cirrhotic patients. In addition, ascitic VEGF-C levels, in association with decreased urinary sodium excretion, may contribute to the prediction of development of RA.