Percutaneous peritoneovenous shunt for treatment of refractory ascites

To evaluate the usefulness of a percutaneously placed peritoneovenous shunt (PVS) in patients with refractory ascites.

Under fluoroscopic and ultrasonographic (US) guidance, the authors placed a PVS in 55 patients (39 men and 16 women; mean age, 56 years) with refractory ascites and symptomatic abdominal distention. The cause of ascites was liver cirrhosis (n = 36), carcinomatosis (n = 17), ruptured cysts with polycystic kidney disease (n = 1), and idiopathic refractory ascites (n = 1). The authors retrospectively evaluated technical feasibility, shunt patency, complications, and clinical outcomes of each patient.

The technical success rate was 100%, and symptomatic improvement was achieved in all but one patient. Complications occurred in 17 of the 55 patients (31%): five patients had variceal bleeding; three patients had ascites leakage; two patients each had disseminated intravascular coagulopathy, transient abdominal pain, shunt infection, and venous thrombosis; and one patient had pulmonary thromboembolism. Thirty patients (54%) died 2-690 days after the procedure (mean, 117 days), and their lifetime shunt patency was 84%. Eight patients were lost to follow-up. Seventeen patients were alive for 60-1,200 days, and their shunt patency was 71%. There was no significant difference in shunt patency between the two groups with benign and malignant ascites.

The percutaneous placement of a PVS was a technically feasible and effective method for symptomatic relief of refractory ascites.