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

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Author notes

  1. Shunsuke Sugawara

    Present address: Department of Radiology, Ebara Hospital, 4-5-10, Higashi-yukigaya, Ohta-ku, Tokyo, 145-0065, Japan

Authors and Affiliations

  1. Department of Radiology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan

    Shunsuke Sugawara & Miyuki Sone

  2. Division of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Yasuaki Arai, Noriaki Sakamoto & Yoshito Takeuchi

  3. Division of Diagnostic Radiology, Shizuoka Cancer Center, 1007, Shimo-nagakubo, Nagaizumi-cho, Suntoh-gun, Shizuoka, 411-8777, Japan

    Takeshi Aramaki, Michihisa Moriguchi & Takahiro Tsushima

  4. Department of Interventional and Diagnostic Radiology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan

    Yozo Sato & Yoshitaka Inaba

  5. Department of Diagnostic Imaging, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Kohtoh-ku, Tokyo, 135-8550, Japan

    Teruko Ueno & Kiyoshi Matsueda

Authors
  1. Shunsuke Sugawara
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  2. Miyuki Sone
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  3. Yasuaki Arai
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  4. Noriaki Sakamoto
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  5. Takeshi Aramaki
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  6. Yozo Sato
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  7. Yoshitaka Inaba
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  8. Yoshito Takeuchi
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  9. Teruko Ueno
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  10. Kiyoshi Matsueda
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  11. Michihisa Moriguchi
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  12. Takahiro Tsushima
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Corresponding author

Correspondence to Shunsuke Sugawara.

Appendix

Appendix

See Table 5.

Table 5 Five Japanese institutions enrolled in this study
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Sugawara, S., Sone, M., Arai, Y. et al. Radiological Insertion of Denver Peritoneovenous Shunts for Malignant Refractory Ascites: A Retrospective Multicenter Study (JIVROSG-0809). Cardiovasc Intervent Radiol 34, 980–988 (2011). https://doi.org/10.1007/s00270-010-0057-y

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  • DOI: https://doi.org/10.1007/s00270-010-0057-y

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