Peritoneovenous Shunt in Treatment of Ascites in Patients with Cirrhosis

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Abstract
Peritoneovenous shunts (LeVeen type) were implanted in 7 patients with cirrhosis complicated by ascites refractory to diuretic treatment. Three patients died of gastrointestinal bleeding and hepatic coma 1-7 wk after the shunt implantation. The patients who died were those with the most severely impaired liver and kidney function. In 2 of the 4 surviving patients (observation time, 5-24 mo.) the shunt was patent during the observation time and ascites disappeared. In the other 2 the shunt closed, in 1 patient repeatedly following several re-implantations. Enhanced urinary Na excretion was observed in patients with patent shunts. After disappearance of ascites, the splanchnic venous pressures became less deranged. Long-term change in plasma volume or circulating albumin mass could not be detected. A patent shunt increases the drainage from the peritoneal cavity, but detectable increment in the overall lymph drainage was only found in a patient with a very low pre-shunt value. The findings do not support the overflow theory of ascites formation but rather the lymph imbalance theory. For clinical evaluation of peritoneovenous shunting in the treatment of ascites a controlled clinical trial is essential.