LeVeen shunts in patients with intractable malignant ascites

LeVeen shunts were placed in ten patients bedridden with intractable malignant ascites in order to improve comfort and ambulation. The procedure was done with local anesthesia and mild sedation in all but one patient. Mild prolongations in clotting studies and hypokalemia were noted in several patients, but severe complications were few: a bleeding diathesis in a jaundiced patient, and venous disease in two. Six of the ten had excellent clinical response and were able to undergo therapy impossible in the presence of massive ascites. Two had moderate benefit but remained bedridden. Two patients gained no relief. Elevated bilirubin and inability to tolerate rapid increase in vascular volume and excrete the fluid load contraindicate the procedure, but the LeVeen shunt appears to be of significant clinical benefit in selected cases of malignant ascites.