Abstract

PURPOSE
Peritoneal venous shunts (PVSs) are widely used for palliating symptoms of refractory malignant ascites and are recognized as one of the practical methods. However, reliable clinical data are insufficient because most previous reports have been small studies from single centers. We conducted a retrospective, multicenter study to evaluate the safety and efficacy of radiologically placed PVSs in patients with malignant refractory ascites.
METHODS
A total of 133 patients with malignant ascites refractory to medical therapies were evaluated for patient characteristics, technical success, efficacy, survival times, adverse events, and changes in laboratory data.
RESULTS
PVSs were successfully placed in all patients and were effective (i.e., improvement of ascites symptoms lasting 7 days or more) in 110 (82.7%). The median duration of symptom palliation was 26 days and median survival time was 41 days. The most frequent adverse event was PVS dysfunction, which occurred in 60 (45.1%) patients, among whom function was recovered with an additional minimally invasive procedure in 9. Abnormalities in coagulation (subclinical disseminated intravascular coagulation) occurred in 37 (27.8%) patients, although only 7 (5.3%) developed clinical disseminated intravascular coagulation. Other major adverse events were gastrointestinal bleeding (9.8%), sepsis (3.8%), and acute heart failure (3.0%). PVS was least effective in patients with elevated serum creatinine, bloody ascites, or gynecologic tumor.
CONCLUSIONS
Radiological PVS is a technically feasible and effective method for palliating the symptoms from refractory malignant ascites, but preoperative evaluation and monitoring the postprocedural complications are mandatory to preclude severe adverse events after PVS.

Links

Publisher Full Text

Authors

Sugawara S, Sone M, Arai Y, Sakamoto N, Aramaki T, Sato Y, Inaba Y, Takeuchi Y, Ueno T, Matsueda K, Moriguchi M, Tsushima T

Institution

Department of Radiology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan. suga_shun@hotmail.com

Source

Cardiovascular and interventional radiology 34:5 2011 Oct pg 980-8

MeSH

Adult
Aged
Aged, 80 and over
Ascites
Female
Humans
Male
Middle Aged
Neoplasms
Palliative Care
Peritoneovenous Shunt
Radiography, Interventional

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

21191592