Smadja C, Tridard D, Franco D
Surgery. 1986 Sep;100(3):535-41.
Twenty-five patients with cirrhosis with a peritoneojugular (LeVeen) shunt had recurrence of ascites because of obstruction of the venous catheter. They were investigated by direct shuntography and angiography of the superior vena cava (SVC). Shuntograms were suggestive of venous obstruction in all patients and showed either complete blockage at the tip of the venous catheter (87%) or partial obstruction (13%). Cavography disclosed a complete obstruction of the SVC or one of its branches in 65% of the patients, a nonobstructive mural thrombus in 17.5%, and sheathing around the catheter in another 17.5%. Blood clots formed at the tip of the catheter and not at its entrance into the vein. Replacement of the venous tubing or a contralateral shunt was successful in only one of eight patients with incomplete obstruction of the SVC. Failure was always due to recurrent venous obstruction. In patients with complete occlusion of the SVC, portal systemic shunts (12 patients) or peritoneosaphenous shunts (two patients) were always successful. These results suggest: that obstruction of the venous tubing of a LeVeen shunt is chiefly caused by the formation of a clot at the outlet of the tubing and that local procedures are prone to failure. Improvement of the long-term results of peritoneojugular shunting in intractable ascites of cirrhosis is clearly dependent on improvement of the venous tubing to decrease its thrombogenicity.
25例患有肝硬化且接受了腹腔颈静脉（LeVeen）分流术的患者因静脉导管阻塞而出现腹水复发。对他们进行了直接分流造影和上腔静脉（SVC）血管造影检查。分流造影显示所有患者均提示静脉阻塞，表现为静脉导管尖端完全堵塞（87%）或部分阻塞（13%）。腔静脉造影显示65%的患者上腔静脉或其分支完全阻塞，17.5%有非阻塞性壁血栓形成，另外17.5%有导管周围包鞘。血凝块在导管尖端形成，而非在其进入静脉处形成。在8例上腔静脉不完全阻塞的患者中，仅1例更换静脉导管或进行对侧分流成功。失败总是由于静脉再次阻塞。在上腔静脉完全闭塞的患者中，门体分流术（12例患者）或腹膜隐静脉分流术（2例患者）总是成功的。这些结果提示：LeVeen分流术的静脉导管阻塞主要是由导管出口处形成血凝块所致，且局部手术容易失败。肝硬化顽固性腹水腹腔颈静脉分流术长期效果的改善显然取决于改善静脉导管以降低其血栓形成倾向。
