Sangisetty and Miner reviewed the use of the peritoneovenous shunt started by Leveen et al. The authors are from Brown University in Providence, Rhode Island.
Patient selection: refractory ascites (poor response to diuretics, rapid formation of ascites fluid, need for frequent paracentesis)
Causes of refractory ascites may include:
(1) end-state cirrhosis
(2) extensive liver metastases
(3) peritoneal carcinomatosis
The peritoneovenous shunt has a subcutaneous tube running from an inflow within the peritoneal fluid to outflow into an upper thoracic vein. A key feature is a one-way valve that only opens when the intraperitoneal pressure is greater than intrathoracic or venous pressure. This prevents reflux of blood into the abdomen.
Benefits:
(1) maintenance of albumin and protein (reduced risk for protein malnutrition)
(2) reduced need for paracentesis
(3) improved quality of life
Contraindications due to risk of shunt occlusion:
(1) high protein in the ascitic fluid
(2) hemorrhagic ascites
Other situations where problems may occur:
(1) peritonitis
(2) gastrointestinal carcinoma (associated with poor overall response to shunt)
Complications may include:
(1) shunt occlusion
(2) tumor spread
(3) DIC
(4) pulmonary edema
(5) pulmonary embolism
(6) infection
(7) perioperative morbidity and mortality
