CardioVascular and Interventional Radiology

, Volume 34, Issue 5, pp 980–988 | Cite as

Radiological Insertion of Denver Peritoneovenous Shunts for Malignant Refractory Ascites: A Retrospective Multicenter Study (JIVROSG-0809)

  • Shunsuke SugawaraEmail author
  • Miyuki Sone
  • Yasuaki Arai
  • Noriaki Sakamoto
  • Takeshi Aramaki
  • Yozo Sato
  • Yoshitaka Inaba
  • Yoshito Takeuchi
  • Teruko Ueno
  • Kiyoshi Matsueda
  • Michihisa Moriguchi
  • Takahiro Tsushima
Clinical Investigation



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.


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.


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.


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.


Denver shunt Interventional radiology Malignant ascites Palliative therapy Peritoneovenous shunt 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Becker G, Galandi D, Blum HE (2006) Malignant ascites: systematic review and guideline for treatment. Eur J Cancer 42:589–597PubMedCrossRefGoogle Scholar
  2. 2.
    Smith EM, Jayson GC (2003) The current and future management of malignant ascites. Clin Oncol 15:59–72CrossRefGoogle Scholar
  3. 3.
    Mamada Y, Yoshida H, Taniai N et al (2007) Peritoneovenous shunts for palliation of malignant ascites. J Nippon Med Sch 74(5):355–358CrossRefGoogle Scholar
  4. 4.
    Zanon C, Grosso M, Aprà F et al (2002) Palliative treatment of malignant refractory ascites by positioning of Denver peritoneovenous shunt. Tumori 88:123–127PubMedGoogle Scholar
  5. 5.
    Tueche SG, Pector JC (2000) Peritoneovenous shunt in malignant ascites. The Bordet institute experience from 1975–1998. Hepatogastroenterology 47:1322–1324PubMedGoogle Scholar
  6. 6.
    Holm A, Halpern NB, Aldrete JS (1989) Peritoneovenous shunt for intractable ascites of hepatic, nephrogenic, and malignant ascites. Am J Surg 158:162–166PubMedCrossRefGoogle Scholar
  7. 7.
    Qazi R, Savlov ED (1982) Peritoneovenous shunt for palliation of malignant ascites. Cancer 49:600–602PubMedCrossRefGoogle Scholar
  8. 8.
    Adam RA, Adam YG (2004) Malignant ascites: past, present, and future. J Am Coll Surg 198(6):999–1011PubMedCrossRefGoogle Scholar
  9. 9.
    Bieligk SC, Calvo BF, Coit DG (2001) Peritoneovenous shunting for gynecologic malignant ascites. Cancer 91(7):1247–1255PubMedCrossRefGoogle Scholar
  10. 10.
    Edney JA, Hill A, Armstrong D (1989) Peritoneovenous shunts palliate malignant ascites. Am J Surg 158:598–601PubMedCrossRefGoogle Scholar
  11. 11.
    Faught W, Kirkpatrick JR, Krepart GV et al (1995) Peritoneovenous shunt for palliation of gynecologic malignant ascites. J Am Coll Surg 180:472–474PubMedGoogle Scholar
  12. 12.
    Gough IR, Balderson GA (1993) Malignant ascites: a comparison of peritoneovenous shunting and nonoperative management. Cancer 71(7):2377–2382PubMedCrossRefGoogle Scholar
  13. 13.
    Ginès P, Arroyo V, Vargas V et al (1991) Paracentesis with intravenous infusion of albumin as compared with peritoneovenous shunting in cirrhosis with refractory ascites. N Engl J Med 325(12):829–835PubMedCrossRefGoogle Scholar
  14. 14.
    Seike M, Maetani I, Sakai Y (2007) Treatment of malignant ascites in patients with advanced cancer: peritoneovenous shunt versus paracentesis. J Gastroenterol Hepatol 22:2126–2166CrossRefGoogle Scholar
  15. 15.
    Söderlund C (1986) Denver peritoneovenous shunting for malignant or cirrhotic ascites: a prospective consecutive series. Scand J Gastroenterol 21(10):1161–1172PubMedCrossRefGoogle Scholar
  16. 16.
    Hyde GL, Eiseman B (1967) Peritoneal arterial shunt for intractable ascites. Arch Surg 95:369–373PubMedCrossRefGoogle Scholar
  17. 17.
    Leveen HH, Christoudias G, Ip M et al (1974) Peritoneovenous shunting for ascites. Ann Surg 180:580–591PubMedCrossRefGoogle Scholar
  18. 18.
    Lund RH, Newkirk JB (1979) Peritoneovenous shunting system for surgical management of ascites. Contemp Surg 14:31–45Google Scholar
  19. 19.
    Schumacher DL, Saclarides TJ, Staren ED (1994) Peritoneovenous shunts for palliation of the patient with malignant ascites. Ann Surg Oncol 1(5):378–381PubMedCrossRefGoogle Scholar
  20. 20.
    Hussain FF, Meer ZF, Lopez AJ (2004) Peritoneovenous shunt insertion for intractable ascites: a district general hospital experience. Cardiovasc Intervent Radiol 27:325–328PubMedCrossRefGoogle Scholar
  21. 21.
    Park JS, Won JY, Park SI et al (2001) Percutaneous peritoneovenous shunt creation for the treatment of benign and malignant refractory ascites. J Vasc Interv Radiol 12:1445–1448PubMedCrossRefGoogle Scholar
  22. 22.
    Won JY, Choi SY, Ko H et al (2008) Percutaneous peritoneovenous shunt for treatment of refractory ascites. J Vasc Interv Radiol 19:1717–1722PubMedCrossRefGoogle Scholar
  23. 23.
    Bratby MJ, Hussain FF, Lopez AJ (2007) Radiological insertion and management of peritoneovenous shunt. Cardiovasc Intervent Radiol 30:415–418PubMedCrossRefGoogle Scholar
  24. 24.
    Cheung DK, Raaf JH (1982) Selection of patients with malignant ascites for a peritoneovenous shunt. Cancer 50:1204–1209PubMedCrossRefGoogle Scholar
  25. 25.
    Moskovitz M (1990) The peritoneovenous shunt: expectations and reality. Am J Gastroenterol 82(8):917–929Google Scholar
  26. 26.
    Parsons SL, Watson SA, Steele RJ (1996) Malignant ascites. Br J Surg 83:6–14PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2010

Authors and Affiliations

  • Shunsuke Sugawara
    • 1
    • 6
    Email author
  • Miyuki Sone
    • 1
  • Yasuaki Arai
    • 2
  • Noriaki Sakamoto
    • 2
  • Takeshi Aramaki
    • 3
  • Yozo Sato
    • 4
  • Yoshitaka Inaba
    • 4
  • Yoshito Takeuchi
    • 2
  • Teruko Ueno
    • 5
  • Kiyoshi Matsueda
    • 5
  • Michihisa Moriguchi
    • 3
  • Takahiro Tsushima
    • 3
  1. 1.Department of RadiologyIwate Medical University School of MedicineMoriokaJapan
  2. 2.Division of Diagnostic RadiologyNational Cancer Center HospitalTokyoJapan
  3. 3.Division of Diagnostic RadiologyShizuoka Cancer CenterShizuokaJapan
  4. 4.Department of Interventional and Diagnostic RadiologyAichi Cancer Center HospitalNagoyaJapan
  5. 5.Department of Diagnostic ImagingThe Cancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
  6. 6.Department of RadiologyEbara HospitalTokyoJapan

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