Semin intervent Radiol 2017; 34(04): 343-348
DOI: 10.1055/s-0037-1608705
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Symptomatic Fluid Drainage: Peritoneovenous Shunt Placement

Hooman Yarmohammadi
1   Department of Interventional Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
,
George I. Getrajdman
1   Department of Interventional Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
› Author Affiliations
Further Information

Publication History

Publication Date:
14 December 2017 (online)

Abstract

Ascites causes significant discomfort and has negative impact on patient's quality of life. Medical therapies including dietary restriction and diuretics are successful in only 40 to 44% of patients with malignant ascites and repeated paracentesis only provides temporary symptomatic relief. Therefore, a more permanent solution is necessary. Indwelling catheters or peritoneovenous shunt placement can provide more permanent symptomatic relief and improve patients' quality of life. Unlike indwelling catheters, peritoneovenous shunts do not limit patients' life style and therefore should be offered as first option in patients who are good candidates. Denver shunt (CareFusion-BD Worldwide) is the current available peritoneovenous shunt. In this article, the indications, contraindications, technical aspects of shunt placement, and techniques to prevent postprocedure complications will be discussed.

 
  • References

  • 1 Smith AN. Peritoneocaval shunt with a Holter valve in the treatment of ascites. Lancet 1962; 1 (7231): 671-672
  • 2 Leveen HH, Christoudias G, Ip M, Luft R, Falk G, Grosberg S. Peritoneo-venous shunting for ascites. Ann Surg 1974; 180 (04) 580-591
  • 3 LeVeen HH, Wapnick S, Grosberg S, Kinney MJ. Further experience with peritoneo-venous shunt for ascites. Ann Surg 1976; 184 (05) 574-581
  • 4 Lund RH, Newkirk J. Peritoneovenous shunting for surgical management of ascites. Contemp Surg 1979; 14: 31-45
  • 5 White MA, Agle SC, Padia RK, Zervos EE. Denver peritoneovenous shunts for the management of malignant ascites: a review of the literature in the post LeVeen Era. Am Surg 2011; 77 (08) 1070-1075
  • 6 Becker G, Galandi D, Blum HE. Malignant ascites: systematic review and guideline for treatment. Eur J Cancer 2006; 42 (05) 589-597
  • 7 Adam RA, Adam YG. Malignant ascites: past, present, and future. J Am Coll Surg 2004; 198 (06) 999-1011
  • 8 Sugawara S, Sone M, Arai Y. , et al. Radiological insertion of Denver peritoneovenous shunts for malignant refractory ascites: a retrospective multicenter study (JIVROSG-0809). Cardiovasc Intervent Radiol 2011; 34 (05) 980-988
  • 9 Won JY, Choi SY, Ko HK. , et al. Percutaneous peritoneovenous shunt for treatment of refractory ascites. J Vasc Interv Radiol 2008; 19 (12) 1717-1722
  • 10 Bieligk SC, Calvo BF, Coit DG. Peritoneovenous shunting for nongynecologic malignant ascites. Cancer 2001; 91 (07) 1247-1255
  • 11 Gough IR, Balderson GA. Malignant ascites. A comparison of peritoneovenous shunting and nonoperative management. Cancer 1993; 71 (07) 2377-2382
  • 12 Rosemurgy AS, Zervos EE, Clark WC. , et al. TIPS versus peritoneovenous shunt in the treatment of medically intractable ascites: a prospective randomized trial. Ann Surg 2004; 239 (06) 883-889 , discussion 889–891
  • 13 Martin LG. Percutaneous placement and management of peritoneovenous shunts. Semin Intervent Radiol 2012; 29 (02) 129-134
  • 14 Tomiyama K, Takahashi M, Fujii T. , et al. Improved quality of life for malignant ascites patients by Denver peritoneovenous shunts. Anticancer Res 2006; 26 (3B, 3b): 2393-2395
  • 15 Zanon C, Grosso M, Aprà F. , et al. Palliative treatment of malignant refractory ascites by positioning of Denver peritoneovenous shunt. Tumori 2002; 88 (02) 123-127
  • 16 Yarmohammadi H, Brody LA, Erinjeri JP. , et al. Therapeutic application of percutaneous peritoneovenous (Denver) shunt in treating chylous ascites in cancer patients. J Vasc Interv Radiol 2016; 27 (05) 665-673
  • 17 Cheung DK, Raaf JH. Selection of patients with malignant ascites for a peritoneovenous shunt. Cancer 1982; 50 (06) 1204-1209
  • 18 Hillaire S, Labianca M, Borgonovo G, Smadja C, Grange D, Franco D. Peritoneovenous shunting of intractable ascites in patients with cirrhosis: improving results and predictive factors of failure. Surgery 1993; 113 (04) 373-379
  • 19 Evans JG, Spiess PE, Kamat AM. , et al. Chylous ascites after post-chemotherapy retroperitoneal lymph node dissection: review of the M. D. Anderson experience. J Urol 2006; 176 (4, Pt 1): 1463-1467
  • 20 Tueche SG, Pector JC. Peritoneovenous shunt in malignant ascites. The Bordet Institute experience from 1975-1998. Hepatogastroenterology 2000; 47 (35) 1322-1324
  • 21 Clara R, Righi D, Bortolini M, Cornaglia S, Ruffino MA, Zanon C. Role of different techniques for the placement of Denver peritoneovenous shunt (PVS) in malignant ascites. Surg Laparosc Endosc Percutan Tech 2004; 14 (04) 222-225
  • 22 Tempero MA, Davis RB, Reed E, Edney J. Thrombocytopenia and laboratory evidence of disseminated intravascular coagulation after shunts for ascites in malignant disease. Cancer 1985; 55 (11) 2718-2721
  • 23 Ragni MV, Lewis JH, Spero JA. Ascites-induced LeVeen shunt coagulopathy. Ann Surg 1983; 198 (01) 91-95
  • 24 Rubinstein D, McInnes I, Dudley F. Morbidity and mortality after peritoneovenous shunt surgery for refractory ascites. Gut 1985; 26 (10) 1070-1073
  • 25 Spreafico C, Patelli G, Lanocita R. , et al. Percutaneous implant of Denver peritoneovenous shunt: a new opportunity for the interventional radiologist [in Italian]. Radiol Med (Torino) 2001; 102 (03) 154-158
  • 26 LeVeen HH, Vujic I, d'Ovidio NG, Hutto RB. Peritoneovenous shunt occlusion. Etiology, diagnosis, therapy. Ann Surg 1984; 200 (02) 212-223
  • 27 Hyde GL, Dillon M, Bivins BA. Peritoneal venous shunting for ascites: a 15-year perspective. Am Surg 1982; 48 (03) 123-127
  • 28 Vesely TM. Central venous catheter tip position: a continuing controversy. J Vasc Interv Radiol 2003; 14 (05) 527-534
  • 29 Bratby MJ, Hussain FF, Lopez AJ. Radiological insertion and management of peritoneovenous shunt. Cardiovasc Intervent Radiol 2007; 30 (03) 415-418
  • 30 Orsi F, Grasso RF, Bonomo G, Monti C, Marinucci I, Bellomi M. Percutaneous peritoneovenous shunt positioning: technique and preliminary results. Eur Radiol 2002; 12 (05) 1188-1192