Peritoneovenous Shunt After Failure of Octreotide Treatment for Chylous Ascites in Lymphangioleiomyomatosis

Lefrou, Laurent; d’Altéroche, Louis; Harchaoui, Yahia; Franco, Dominique; Metman, Etienne Henry

doi:10.1007/s10620-006-9353-4

Cited by 6 publications

(3 citation statements)

References 10 publications

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“…Peritoneal disease, including Lymphangioleiomyomatosis (LAM) and peritoneal mesothelioma was also associated with higher incidence of occlusion. This is similar to previous case reports in which the shunt occluded in three out of four patients (75%) with LAM (21, 28, 32, 33). Therefore, when counseling patients with LAM, they should be advised that they are at increased risk for shunt malfunction.…”

Section: Discussionsupporting

confidence: 92%

Therapeutic Application of Percutaneous Peritoneovenous (Denver) Shunt in Treating Chylous Ascites in Cancer Patients

Yarmohammadi¹,

Brody²,

Erinjeri³

et al. 2016

Journal of Vascular and Interventional Radiology

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Purpose Chylous ascites (CA) is an uncommon complication of abdominal surgeries and malignancies. The purpose of this study was to evaluate the safety and efficacy of PPVS in treating intractable CA in cancer patients. Materials and Methods 28 patients with refractory CA treated with PPVS from April 2001 to June 2015 were reviewed. Demographic characteristics, technical success, efficacy, laboratory values and complications were recorded. Univariate and multivariate logistic regression analysis was performed. Results Technical success was 100% and ascites resolved or symptoms were relieved in 92.3% (26 out of 28) of patients. In 13 (46%) of these patients with urologic malignancies, whose ascites had resulted from retroperitoneal lymph node dissection ascites resolved resulting in shunt removal within 128±84 days. The shunt provided palliation of symptoms in 13 of the remaining 15 patients (87%); mean duration of 198±214 days). Serum albumin levels increased significantly (21.4%) following PPVS placement; from a pre-procedure mean of 2.98±0.64g/dl to 3.62±0.83g/dl(p < 0.001). Post-procedure complication rate was 37%, including shunt malfunction/occlusion (22%), venous thrombosis (7%), subclinical disseminated intravascular coagulopathy (DIC) (7%). Smaller venous limb size(11.5 F) and the presence of peritoneal tumor were associated with a higher rate of shunt malfunction(p < 0.05). No patient developed overt DIC. Conclusion PPVS can safely and effectively treat CA in cancer patients, resulting in significant improvement in serum albumin in addition to palliation of symptoms.

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Section: Discussionsupporting

confidence: 92%

Therapeutic Application of Percutaneous Peritoneovenous (Denver) Shunt in Treating Chylous Ascites in Cancer Patients

Yarmohammadi¹,

Brody²,

Erinjeri³

et al. 2016

Journal of Vascular and Interventional Radiology

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“…In one patient with LAM, octreotide was reported to exert a temporary effect on ameliorating chylothorax ( 13 ). However, other reports have found that octreotide monotherapy was not effective in ameliorating chylous effusion ( 3 , 7 , 11 , 18 ). In the present case, combination therapy of octreotide, which decreases the lymph flow, and sirolimus, which inhibits the proliferation of LAM cells, may have ameliorated the chylous effusion.…”

Section: Discussionmentioning

confidence: 84%

“…One is non-invasive and involves a fat-restricted diet, hormone therapy and octreotide. The other is invasive and involves pleural/peritoneal drainage, pleurodesis, ligation of the thoracic duct, peritoneovenous shunting ( 10 , 11 ) and cell-free concentrated ascites reinfusion therapy (CART) ( 12 , 13 ). It is generally thought that we should initially employ a non-invasive approach, especially a fat-restricted diet.…”

Section: Discussionmentioning

confidence: 99%

Additional Octreotide Therapy to Sirolimus Achieved a Decrease in Sirolimus-refractory Chylous Effusion Complicated with Lymphangioleiomyomatosis

et al. 2017

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Recently, sirolimus, an inhibitor of mammalian target of rapamycin, was reported to decrease chylous effusion in patients with lymphangioleimyomatosis (LAM). We herein report a case of a 34-year-old woman with LAM who developed refractory chylothorax and chylous ascites during sirolimus therapy. In this case, to reduce chylous effusion, we administered octreotide, which is often used to control postoperative chylous effusion, in addition to the sirolimus therapy. This combination therapy reduced the chylothorax and chylous ascites. For patients with LAM, octreotide therapy in addition to sirolimus may be effective for treating sirolimus-refractory chylous effusion.

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Local Complications

Duncan¹

2010

Rutherford's Vascular Surgery

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Peritoneovenous Shunt After Failure of Octreotide Treatment for Chylous Ascites in Lymphangioleiomyomatosis

Cited by 6 publications

References 10 publications

Therapeutic Application of Percutaneous Peritoneovenous (Denver) Shunt in Treating Chylous Ascites in Cancer Patients

Therapeutic Application of Percutaneous Peritoneovenous (Denver) Shunt in Treating Chylous Ascites in Cancer Patients

Additional Octreotide Therapy to Sirolimus Achieved a Decrease in Sirolimus-refractory Chylous Effusion Complicated with Lymphangioleiomyomatosis

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