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Related Experiment Videos

The peritoneovenous shunt: expectations and reality.

M Moskovitz1

  • 1Department of Internal Medicine, Medical Center, Beaver, Pennsylvania.

The American Journal of Gastroenterology
|August 1, 1990
PubMed
Summary

Peritoneovenous shunts (PVS) offer ascites control in liver disease but do not prolong survival. Complications are common, and shunt function declines over time, necessitating careful patient selection and management.

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Area of Science:

  • Medical Devices
  • Gastroenterology
  • Surgical Interventions

Background:

  • The LeVeen peritoneovenous shunt (PVS) has been used since 1974, primarily for intractable ascites in chronic liver disease.
  • While effective for ascites management, its impact on survival and hepatorenal syndrome (HRS) remains debated.

Purpose of the Study:

  • To review the efficacy, survival rates, and complications associated with peritoneovenous shunts.
  • To evaluate the PVS in patients with chronic liver disease and intractable ascites or HRS.

Main Methods:

  • Systematic review of studies on peritoneovenous shunt placement.
  • Analysis of perioperative mortality, survival rates, ascites resolution, and complication incidence.

Main Results:

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  • Perioperative mortality is approximately 18%; 21-month survival is 46%.
  • Ascites resolution occurs in 59% of survivors at 18 months; PVS does not significantly prolong survival.
  • Shunt patency is a significant issue, with only 18.6% functioning at 2 years; common complications include coagulopathy, fluid overload, and infections.

Conclusions:

  • Peritoneovenous shunts can manage ascites and shorten hospitalizations but do not improve survival in liver disease or HRS.
  • Best outcomes are seen in patients with milder liver disease; alcohol abstinence may improve hepatic function and affect shunt performance.
  • Serious complications, including shunt malfunction and infection, require vigilant monitoring and management.