Peritoneovenous shunt in treatment of ascites in patients with cirrhosis. A preliminary report with special reference to pathophysiology
Research output: Contribution to journal › Journal article › Research › peer-review
Peritoneovenous shunts (LeVeen type) were implanted in seven patients with cirrhosis complicated by ascites refractory to diuretic treatment. Three patients died of gastrointestinal bleeding and hepatic coma 1 to 7 weeks after the shunt implantation. The patients who died were those with the most severely impaired liver and kidney function. In two of the four surviving patients (observation time, 5-24 months) the shunt was patent during the observation time, and ascites disappeared. In the other two the shunt closed, in one patient repeatedly following several re-implantations. Enhanced urinary sodium 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.
Original language | English |
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Journal | Scandinavian Journal of Gastroenterology |
Volume | 18 |
Issue number | 4 |
Pages (from-to) | 529-35 |
Number of pages | 6 |
ISSN | 0036-5521 |
Publication status | Published - 1983 |
Bibliographical note
Keywords: Aged; Albumins; Ascites; Female; Hemodynamics; Humans; Kidney Function Tests; Liver Cirrhosis; Liver Function Tests; Male; Middle Aged; Peritoneovenous Shunt; Vascular Surgical Procedures
ID: 19397836