Central venous thrombosis and embolism associated with peritoneovenous shunts

During a five-year period from Aug 1, 1977 through Aug 1, 1982, 36 patients required 47 peritoneovenous shunt procedures (36 initial and 11 revisions) for the management of their intractable ascites. The results at six months showed 23 (63.9%) of 36 patients were dead, but in those living, 12 (92.3%) of 13, the ascites was satisfactorily controlled. Patency was measurably prolonged by appropriate revision of the shunt. The early and late complication rates were surprisingly high, 38.3% and 40.4%, respectively. The most serious complication was central venous thrombosis, 11 (23.4%) of 47 procedures, including one nonfatal and two fatal pulmonary emboli. Treatment included the use of fibrinolytic agents, anticoagulation, and shunt revisions. Careful attention to the details of shunt fabrication, insertion, and patient selection may help to reduce the occurrence of central venous thrombosis associated with peritoneovenous shunts.