Hooman Yarmohammadi MD, Presenter: Nothing to Disclose

Lynn Alison Brody MD, Abstract Co-Author: Nothing to Disclose

Joseph Patrick Erinjeri MD, PhD, Abstract Co-Author: Nothing to Disclose

Anne Mara Covey MD, Abstract Co-Author: Nothing to Disclose

Constantinos Thasos Sofocleous MD, PhD, Abstract Co-Author: Consultant, Sirtex Medical Ltd

Jeremy C. Durack MD, Abstract Co-Author: Scientific Advisory Board, Investor - Adient Medical Research Grants - Society of Interventional Radiology Foundation, Prostate Cancer Foundation

Majid Maybody MD, Abstract Co-Author: Nothing to Disclose

Robert H. Siegelbaum MD, Abstract Co-Author: Nothing to Disclose

Karen Teresa Brown MD, Abstract Co-Author: Nothing to Disclose

Raymond Howard Thornton MD, Abstract Co-Author: Nothing to Disclose

Stephen Barnett Solomon MD, Abstract Co-Author: Research Grant, General Electric Company Research Grant, AngioDynamics, Inc Consultant, Johnson & Johnson Consultant, Covidien AG Director, Devicor Medical Products, Inc Director, Aspire Bariatrics, Inc

George Isaac Getrajdman MD, Abstract Co-Author: Medical Advisory Board, CareFusion Corporation

Management of intractable chylous ascites in cancer patients remains a challenge. Both nutritional status and quality of life are adversely affected. Denver shunts have been used to manage both malignant and chylous ascites. The purpose of this study was to evaluate the efficacy of Denver shunt placement in treating intractable chylous ascites in cancer patients.

This is a retrospective review of patients with refractory chylous ascites who had Denver shunts placed between February 2003 and July 2013. Demographic characteristics, technical success rate, efficacy in providing symptomatic relief, shunt survival time, and complications were recorded and analyzed. Symptomatic relief was defined as absence of discomfort from abdominal distention. Control of ascites was assessed on follow up imaging and physical examination. Univariate logistic regression was performed to determine factors correlating with complications, complete resolution of ascites and shunt removal. 

23 Denver shunts were placed in 11 men and 12 women with a mean age of 49±13 years (Range: 25-78 years). Shunts were successfully placed in all 23 patients (100% technical success) and provided symptomatic relief in all patients (100%). Chylous ascites completely resolved in 10 patients (43%) leading to shunt removal in 160±90 days (range 48-301 days). Ascites did not recur after removal in any of these patients during mean follow-up of 15±11 months. Chylous ascites completely resolved in all patients with testicular cancer (n = 7). The most common complication was shunt malfunction; clogging or obstruction of the venous or peritoneal limb requiring shunt removal occurred in 2/23 patients (8.7%). Two other shunts had to be removed due to right internal jugular vein thrombosis and superior vena cava thrombosis. There was no case of disseminated intravascular coagulation. Diagnosis, type of surgery, changes in platelet count, and fibrinogen level were unrelated to adverse events (p>0.05).

Denver shunts successfully managed chylous ascites in cancer patients, particularly in the setting of post-operative patients with testicular cancer, leading to complete resolution of ascites and allowing shunt removal.

When dealing with ascites, Denver shunt placement can safely and efficiently treat and managing ascites.

Yarmohammadi, H, Brody, L, Erinjeri, J, Covey, A, Sofocleous, C, Durack, J, Maybody, M, Siegelbaum, R, Brown, K, Thornton, R, Solomon, S, Getrajdman, G, Peritoneovenous (Denver) Shunt use for Management of Chylous Ascites in Cancer Patients.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14016095.html