LeVeen shunt

A procedure that places a surgically implanted connecting the peritoneal cavity and the superior vena cava to drain accumulated fluid from the peritoneal cavity.

It is used in cirrhosis of the liver, right-sided heart failure, or abdominal cancer associated with ascites.

Under general anesthesia, a silicone rubber tube is inserted under the subcutaneous tissue from the peritoneal cavity to the superior vena cava.

With inhalation the fluid pressure in the abdomen increases, and the pressure in the superior vena cava drops and allows peritoneal fluid to enter the shunt which has a valve preventing return of the fluid to the abdomen.

The valve opens with a low pressure gradient–3 cm H2O.

In a study of 140 patients with intractable ascites complicating a chronic liver disease received a peritoneovenous shunt using the LeVeen valve, resulted in a 1 year survival of 81.4%, 30.5% had recurrence of ascites (Smadja C).

In a randomized study of 57 patients with alcoholic cirrhosis and refractory ascites; 29 patients received a LeVeen shunt and 28 were treated by conventional medical therapy: The effectiveness of the LeVeen shunt was not different from conventional medical therapy by the end of one year (Bories P).

In the above study complications were significantly more frequent in the surgical group with 29 patients fitted with a LeVeen shunt, 25 developed one or more complications, while of the 28 patients in the medical control group, only 8 developed complications, the mortality rate in the surgical group (41%) died in the course of the first month against only 5 (18%) in the medical control group(Bories P).

In the above study by the end of one year, the mortality rate of the two groups was almost identical: 23 (79%) and 21 (75%) respectively (Bories P).

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