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September 14, 1984

Nonsurgical Relief of Venous Limb Thrombosis in a Denver Shunt

Author Affiliations

Dartmouth-Hitchock Medical Center Hanover, NH

JAMA. 1984;252(10):1282-1283. doi:10.1001/jama.1984.03350100016018

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