PERITONEOVENOUS SHUNTS IN PATIENTS WITH INTRACTABLE ASCITES - PALLIATION AT WHAT PRICE

Intractable ascites carries great morbidity by affecting appetite, mob ility, and quality of life. Peritoneovenous shunts (PVSs) are utilized to abate intractable ascites, although long-term efficacy is unestabl ished. Thirty male and 18 female cirrhotics, 55 +/- 12 (standard devia tion) years of age, failed multiple large-volume paracenteses and diur etic therapy before undergoing PVS. Data were collected until death or the present time. Nine patients (19%) are alive and palliated, four w ith working shunts [average follow-up (ave. f/u), 30 months] and five without shunts (ave. f/u, 19 months). Thirty-two (67%) patients died: 18 palliated with functional shunts (survival time, 4.4 +/- 5.7 months ), 8 unpalliated with dysfunctional shunts (ave. f/u, 3.9 +/- 4.5 mont hs), 4 unpalliated with shunts removed (ave. f/u 5.5 +/- 4.7 months), and 2 with unknown shunt function at death. Function was lost to occlu sion in 26 patients, infection in 9, and ligation for disseminated int ravascular coagulation in 3. Thirteen patients underwent 18 shunt repl acements. At death/present time, 22 (46%) patients were palliated with functioning shunts. Seven patients were lost to follow-up. PVSs provi de palliation for intractable ascites short term, but commonly occlude within 1 year. Despite palliation, complications with PVSs are high, and survival is limited.