Peritoneovenous shunt

Peritoneovenous Shunt is a medical procedure used to treat ascites, which is the accumulation of fluid in the peritoneal cavity causing abdominal swelling. Ascites can result from various conditions, most commonly liver cirrhosis, heart failure, or cancer. The peritoneovenous shunt, also known as a LeVeen shunt, after its inventor, is designed to reroute ascitic fluid from the peritoneal cavity back into the venous system, thereby relieving the symptoms associated with ascites.

Indications

The primary indication for a peritoneovenous shunt is refractory ascites, which is ascites that cannot be managed by medical therapy alone, including dietary sodium restriction and diuretic therapy. Patients with malignant ascites, hepatic hydrothorax, and those who are not candidates for or have failed liver transplantation may also be considered for this procedure.

Procedure

The peritoneovenous shunt procedure involves the surgical insertion of a shunt, which is a tube that connects the peritoneal cavity to a vein, typically the superior vena cava or the jugular vein. This allows the ascitic fluid to be absorbed into the bloodstream. The shunt contains a one-way valve to prevent the backflow of blood into the peritoneal cavity.

Complications

Complications of the peritoneovenous shunt procedure can include shunt occlusion, infection, deep vein thrombosis, and pulmonary embolism. There is also a risk of inducing hepatic encephalopathy due to the increased load of substances from the ascitic fluid entering the systemic circulation, which the liver may not be able to adequately detoxify.

Outcomes

The effectiveness of peritoneovenous shunting in relieving the symptoms of ascites is significant; however, it does not address the underlying cause of the ascites. Therefore, it is considered a palliative treatment. The procedure can improve the quality of life for patients with refractory ascites, but it is associated with a high complication rate, which has led to a decline in its use in favor of other treatments such as paracentesis and transjugular intrahepatic portosystemic shunt (TIPS).

See Also

• Liver cirrhosis
• Ascites
• Transjugular intrahepatic portosystemic shunt
• Paracentesis

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