title: Therapeutic Application of Percutaneous Peritoneovenous (Denver) Shunt in Treating Chylous Ascites in Cancer Patients.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of percutaneous peritoneovenous shunt (PPVS) placement in treating intractable chylous ascites (CA) in patients with cancer.
  
  
  METHODS
  Data from 28 patients with refractory CA treated with PPVS from April 2001 to June 2015 were reviewed. Demographic characteristics, technical success, efficacy, laboratory values, and complications were recorded. Univariate and multivariate logistic regression analysis was performed.
  
  
  RESULTS
  Technical success was 100%, and ascites resolved or symptoms were relieved in 92.3% (26 of 28) of patients. In 13 (46%) patients with urologic malignancies, whose ascites had resulted from retroperitoneal lymph node dissection, the ascites resolved, resulting in shunt removal within 128 days ± 84. The shunt provided palliation of symptoms in 13 of the remaining 15 patients (87%) for a mean duration of 198 days ± 214. Serum albumin levels increased significantly (21.4%) after PPVS placement from a mean of 2.98 g/dL ± 0.64 before the procedure to 3.62 g/dL ± 0.83 (P < .001). The complication rate was 37%, including shunt malfunction/occlusion (22%), venous thrombosis (7%), and subclinical disseminated intravascular coagulopathy (DIC) (7%). Smaller venous limb size (11.5 F) and the presence of peritoneal tumor were associated with a higher rate of shunt malfunction (P < .05). No patient developed overt DIC.
  
  
  CONCLUSIONS
  PPVS can safely and effectively treat CA in patients with cancer, resulting in significant improvement in serum albumin in addition to palliation of symptoms.
authors.affiliation: Department of Interventional Radiology, 1275 York Avenue, New York, NY 10065. Electronic address: yarmohah@mskcc.org.
authors.forename: Hooman
authors.initials: H
authors.lastname: Yarmohammadi
authors.affiliation: Department of Interventional Radiology, 1275 York Avenue, New York, NY 10065.
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Brody
authors.affiliation: Department of Interventional Radiology, 1275 York Avenue, New York, NY 10065.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Erinjeri
authors.affiliation: Department of Interventional Radiology, 1275 York Avenue, New York, NY 10065.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Covey
authors.affiliation: Department of Interventional Radiology, 1275 York Avenue, New York, NY 10065.
authors.forename: F Edward
authors.initials: FE
authors.lastname: Boas
authors.affiliation: Department of Interventional Radiology, 1275 York Avenue, New York, NY 10065.
authors.forename: Etay
authors.initials: E
authors.lastname: Ziv
authors.affiliation: Department of Interventional Radiology, 1275 York Avenue, New York, NY 10065.
authors.forename: Majid
authors.initials: M
authors.lastname: Maybody
authors.affiliation: Department of Interventional Radiology, 1275 York Avenue, New York, NY 10065.
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Gonzalez-Aguirre
authors.affiliation: Department of Interventional Radiology, 1275 York Avenue, New York, NY 10065.
authors.forename: Karen T
authors.initials: KT
authors.lastname: Brown
authors.affiliation: Department of Urology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065.
authors.forename: Joel
authors.initials: J
authors.lastname: Sheinfeld
authors.affiliation: Department of Interventional Radiology, 1275 York Avenue, New York, NY 10065.
authors.forename: George I
authors.initials: GI
authors.lastname: Getrajdman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002915:Chylous Ascites / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications*; D010166:Palliative Care; D010536:Peritoneovenous Shunt / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D000075462:Serum Albumin, Human; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology; D055815:Young Adult
chemical_list: C422455:ALB protein, human; D015415:Biomarkers; D012709:Serum Albumin; D000075462:Serum Albumin, Human