title: Implantation of a Denver shunt by left subclavian approach for preventing kinking.
abstract: Ascites often contributes to patient morbidity and discomfort. Implantation of a Denver peritoneovenous shunt is one of the treatments for refractory ascites. However, the dysfunction of the shunt is frequently observed and requires further improvement. Here, the present paper reported the improved implantation technique for the Denver peritoneovenous shunt. All the procedures were performed in the operating suite under general anesthesia. In all patients, the shunts were percutaneously placed via the left subclavian vein approach under digital fluoroscopic guide along with ultrasound. Fourteen shunts were implanted in 14 patients with hepatic failure-related ascites. The shunt was successfully positioned in all patients in an average time of 45 min without the kinking. No complications directly related to the procedure occurred. The Denver peritoneovenous shunt is useful in resolution of refractory ascites, as it reduces symptoms, and allows effective palliation. Implantation of the Denver peritoneovenous shunt via left subclavian vein approach is a relatively easy, rapid, and secure procedure that prevents kinking.
authors.affiliation: Department of Surgery, Social Insurance Yokohama Central Hospital, 268 Yamashita-cho, Naka-ku, Yokohama 231-8553, Japan. ooida.takatsugu@yokochu.jp
authors.forename: Takatsugu
authors.initials: T
authors.lastname: Oida
authors.forename: Kenji
authors.initials: K
authors.lastname: Mimatsu
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawasaki
authors.forename: Hisao
authors.initials: H
authors.lastname: Kanou
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kuboi
authors.forename: Shun-ichi
authors.initials: S
authors.lastname: Matsuoka
authors.forename: Sadao
authors.initials: S
authors.lastname: Amano
mesh_terms: D000368:Aged; D001201:Ascites / Q000209:etiology / Q000628:therapy*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010536:Peritoneovenous Shunt / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D013350:Subclavian Vein; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional