To the Editor.—
The Denver peritoneovenous shunt, with its valved pump chamber and heparin-bonded tubing, may offer prolonged patency when compared with other types of peritoneovenous shunts. However, shunt thrombosis is a troublesome complication that usually requires operative revision.The patient with intractable ascites secondary to hepatic cirrhosis presents a therapeutic challenge. Even though the additional volume load imposed by a peritoneovenous shunt may be hemodynamically tolerated, a reduced peritoneovenous pressure gradient decreases flow through the shunt and puts the paient at high risk for thrombosis of the venous end of the tubing. We recently treated such a patient.
Report of a Case.—
A 63-year-old man had, in addition to medically intractable ascites from biopsy-proved Laennec's cirrhosis, multiple medical problems including mild right-sided heart failure associated with previous myocardial infarction and atrial fibrillation. Because of his chronically elevated central venous pressure (30 mm Hg), he was followed up expectantly until
McDaniel MD, Lewis TH. Nonsurgical Relief of Venous Limb Thrombosis in a Denver Shunt. JAMA. 1984;252(10):1282-1283. doi:10.1001/jama.1984.03350100016018