Percutaneous peritoneovenous shunt positioning: technique and preliminary results

Orsi, Franco; Grasso, Rosario Francesco; Bonomo, Guido; Monti, Cinzia; Marinucci, Irene; Bellomi, Massimo

doi:10.1007/s003300101049

Cited by 21 publications

(13 citation statements)

References 9 publications

(14 reference statements)

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“…The insertion operation was performed under local anesthesia in an angiographic suite. Percutaneous insertion of the PVS device was performed essentially as described by Orsi et al ., 3 with the exception that postoperative diuretics were administered only when necessary for the treatment of pulmonary edema. The left subclavian vein was selected as the approach route to the venous access, primarily because the insertion of sheaths and tubes was easier by this route.…”

Section: Methodsmentioning

confidence: 99%

Treatment of malignant ascites in patients with advanced cancer: Peritoneovenous shunt versus paracentesis

Seike¹,

Maetani²,

Sakai³

2007

J of Gastro and Hepatol

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Section: Methodsmentioning

confidence: 99%

Treatment of malignant ascites in patients with advanced cancer: Peritoneovenous shunt versus paracentesis

Seike¹,

Maetani²,

Sakai³

2007

J of Gastro and Hepatol

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“…Ascites is a common sign of several diseases, both benign and malignant, and often contributes to more symptoms than the underlying pathology itself 1. Malignant ascites (MA) is an abnormal accumulation of fluid in the peritoneal cavity as a result of cancer,2 and accounts for ~10% of all cases of ascites.…”

Section: Introductionmentioning

confidence: 99%

Drainage of malignant ascites: patient selection and perspectives

Stukan¹

2017

CMAR

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Malignant ascites (MA) is a sign of advanced cancer and poor prognosis. MA can result in impairment in quality of life (QOL) and significant symptoms. As a supportive treatment, ascites can be drained by paracentesis (PC), percutaneously implanted catheters (tunneled, untunneled, central venous catheters), or peritoneal ports, or peritoneovenous shunts. The aim of this study was to evaluate the effectiveness, safety, and patient-reported outcomes (PRO) of different drainage methods for the management of MA. A systematic review of the literature was performed, and 32 original articles met the inclusion criteria. Patients selected for permanent drain insertion demonstrated symptoms related to MA and had undergone repeated PC. The primary focus of the reviewed articles was procedural safety issues. The rate of technical success of drainage device installation was 100%. Most patients experienced improvements in symptom control after ascites drainage. When analyzed together, 19.7% (255/1297) of patients experienced any complication and 6.2% (81/1297) experienced serious adverse events during MA drainage. Complications were reported for every drainage method; however, the least occurred after PC or central venous catheter, while the most serious occurred after peritoneovenous shunts. Adverse events were as follows: catheter obstruction: 4.4%, infection: 4.1%, leakage: 3.5%, catheter dislodgment: 2.3%, hypotension: 0.6%, injuries during device insertion: 0.6%, renal impairment: 0.5%, electrolyte imbalance: 0.2%, other: 3.6%. PRO and QOL endpoints were available for 12 studies. When PRO were measured using an interview, a significant improvement in symptom control and QOL was reported in almost all patients. Once standardized questionnaires were used, improvements in symptomatic scores and role functioning were observed. Deterioration was observed in cognitive and emotional subscales. MA drainage is a safe and effective method to control symptoms associated with ascites, and should be perceived as a supportive care, that can be applied for those who need it at any time of their cancer trajectory. Patient selection should be performed using a thorough assessment of symptoms and QOL, and should not be delayed.

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“…Percutaneous peritoneovenous shunt placement [26] and subcutaneous access ports [27] have been attempted on small numbers of patients, but efficacy in large numbers of patients is unknown. An ascites bladder drain that would provide a means of ascites excretion through the bladder currently is being developed.…”

Section: Sbp Prophylaxismentioning

confidence: 99%

Treatment of refractory ascites

Velamati

Herlong

2006

Curr Treat Options Gastro

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In 1996, the International Ascites Club defined "refractory ascites" as ascites that cannot be mobilized by medical therapy or that recurs early after initial mobilization despite continued treatment. Of all patients with ascites, 5% to 10% will become refractory to medical therapy. Management of refractory ascites should attempt to control fluid accumulation, reduce the likelihood of developing complications such as spontaneous bacterial peritonitis (SBP) and the hepatorenal syndrome, and improve the patient's nutritional status and overall well-being. Measures to control ascites accumulation include documenting medication and dietary compliance and eliminating potentially nephrotoxic agents that promote sodium retention. Large volume paracentesis is an effective first step in managing these patients and can be performed routinely in an outpatient setting. When more than 5 L of fluid are removed during a paracentesis, intravenous albumin should be infused to reduce the likelihood of the patient developing postparacentesis circulatory dysfunction. Transjugular intrahepatic portosystemic shunt (TIPS) placement effectively eliminates ascites; however, there is no convincing evidence that the shunt improves mortality. Furthermore, it is associated with frequent complications of encephalopathy and shunt malfunction. We feel TIPS should be reserved for patients requiring extremely frequent paracentesis, those who develop significant postparacentesis circulatory dysfunction, or those with hepatic hydrothorax. Patients who have evidence of SBP should be treated with antibiotics and intravenous albumin infusion. Patients who have had a previous episode of SBP or an ascitic fluid protein level of less than 1.0 should receive prophylactic antibiotics. Overall, the prognosis for patients with refractory ascites remains grim, and liver transplantation is the only definitive therapy. Appropriate candidates should be identified promptly and referred for transplant evaluation.

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Percutaneous peritoneovenous shunt positioning: technique and preliminary results

Cited by 21 publications

References 9 publications

Treatment of malignant ascites in patients with advanced cancer: Peritoneovenous shunt versus paracentesis

Treatment of malignant ascites in patients with advanced cancer: Peritoneovenous shunt versus paracentesis

Drainage of malignant ascites: patient selection and perspectives

Treatment of refractory ascites

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