Peritoneovenous shunting for intractable ascites.

Ten patients with intractable ascites were treated with the LeVeen peritoneovenous shunt. Of these, three died perioperatively. Three patients with malignant ascites died within 2-3 months, but with good shunt function. In four patients, the shunt became occluded, after 2 weeks to 8 months. Percutaneous puncture of the shunt and injection of radiopaque dye revealed the occlusion t be due to thrombosis of the venous limb of the shunt. In one patient, superior vena cava thrombosis occurred. Another ten patients were treated with the Denver peritoneovenous shunt. One patient died perioperatively; four patients with malignant ascites and one with cirrhosis died after 11 days-3 months, but with good shunt function. One patient with cirrhosis is alive after 5 months, with good function. In three patients the shunt became occluded after 5 days-1 month but two of these could be cleared with the fluschchamber of the Denver shunt. It seems that the Denver shunt functions better than the LeVeen shunt, and that the primary indication for peritoneovenous shunting is malignant ascites. Here palliation is excellent. No patient developed clinical signs of disseminated intravascular coagulation following ascites infusion and in six patients where coagulation variables were studed, there were no signs of a consumption coagulopathy.