[Local lysis of peritoneovenous shunt thrombosis with rt-PA]

We report five instances of local lysis with rt-PA (recombinant tissue type plasminogen activator) in three patients with thrombotic occlusions of their peritoneovenous Denver shunts (PVS). In all cases liver cirrhosis was alcohol-induced and ascites was refractory to all medical measures. Because of rethrombosis two patients were treated again after 13 months. The occlusion had occurred 2-30 days before treatment. In four of the five instances the local lysis was successful. Complications were rare. This scintigraphic visualization of the catheter system allowed assessment of shunt patency under physiological flow conditions. The local lysis of a thrombotic shunt with rt-PA and scintigraphic monitoring is a low-risk alternative to reoperation. Possible benefits compared to other fibrinolytics must be confirmed by a greater patient collective.