title: Radiological insertion of Denver peritoneovenous shunts for malignant refractory ascites: a retrospective multicenter study (JIVROSG-0809).
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Radiology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan. suga_shun@hotmail.com
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Sugawara
authors.forename: Miyuki
authors.initials: M
authors.lastname: Sone
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Arai
authors.forename: Noriaki
authors.initials: N
authors.lastname: Sakamoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Aramaki
authors.forename: Yozo
authors.initials: Y
authors.lastname: Sato
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Inaba
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: Teruko
authors.initials: T
authors.lastname: Ueno
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Matsueda
authors.forename: Michihisa
authors.initials: M
authors.lastname: Moriguchi
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tsushima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010166:Palliative Care; D010536:Peritoneovenous Shunt / Q000009:adverse effects / Q000295:instrumentation*; D015641:Radiography, Interventional