LeVeen vs Denver peritoneovenous shunts for intractable ascites of cirrhosis. A randomized, prospective trial
J. T. Fulenwider, J. D. Galambos, R. B. Smith 3rd, J. M. Henderson and W. D. Warren
Peritoneovenous shunts (PVSs) have provided salutary effects on medically
recalcitrant ascites, functional renal impairment, nutritional
derangements, ventilatory embarrassment, and locomotion potential in
patients with cirrhosis. While the LeVeen (LPVS) and Denver (DPVS) PVSs are
most frequently implanted in such patients, postoperative complications of
bleeding gastroesophageal varices, sepsis, and shunt occlusion occur with
notable frequency. Addressing primarily the complication of PVS occlusion,
a randomized prospective trial of LPVSs and DPVSs was conducted in
cirrhotic patients with refractory ascites. From July 1, 1982 to July 1,
1984, 26 initial PVSs were implanted for hepatic-related intractable
ascites. Twenty-two patients were eligible for randomization (cirrhosis,
sterile ascites, initial PVS, total bilirubin level less than or equal to
6.0 mg/dL, prothrombin time less than or equal to 5-s prolongation, serum
creatinine level less than or equal to 2.0 mg/dL [creatinine clearance rate
greater than or equal to 20 mL/min], absence of recent [less than 30 days]
bleeding gastroesophageal varices, or absent spontaneous encephalopathy).
Twelve LPVSs and ten DPVSs were implanted; however, one patient with a DPVS
was found to have hepatic polycystic disease and was excluded from
analysis. All patients were followed up until death or Jan 1, 1985. The PVS
patency determinations included contrast shuntography, technetium Tc 99m
albumin scintigraphy, sequential manual compression (DPVS), and operative
or autopsy observation. Using the Kaplan-Meier actuarial analysis, the LPVS
patency proved to be highly superior to that of the DPVS, while survival
was not significantly different. As LPVS and DPVS complications other than
patency are comparable, the LPVS is preferred for its superior patency in
cirrhotic patients with intractable ascites.
