Nonsurgical Relief of Venous Limb Thrombosis in a Denver Shunt

Martha D. McDaniel, MD; Thomas H. Lewis, MD
JAMA. 1984;252(10):1282-1283. doi:10.1001/jama.1984.03350100016018.
Text Size: A A A
Published online

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


Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.