Mitigation of Sarcopenia after Peritoneovenous Shunt Placement in Patients with Refractory Ascites.

Abstract

PURPOSE:

To evaluate the effect of peritoneonvenous shunt placement on metrics of sarcopenia in patients with refractory ascites.

MATERIALS AND METHODS:

An institutional review board-approved single-institution retrospective analysis of all patients who underwent peritoneovenous shunt (Denver Shunt; BD, Franklin Lakes, New Jersey) placement (N = 29) and a comparator cohort of patients with cirrhosis who underwent serial paracentesis (N = 42) from 2009 to 2019 with baseline and follow-up cross-sectional imaging of at least 3 months was performed. Axial muscle area measurements (psoas, paraspinal, and total abdominal wall) were performed using free-hand region-of-interest technique. Patient records were reviewed for demographic characteristics, referring indication, laboratory studies, and performance status. Statistical analyses were performed with Student t test, Welch unequal variances, Fisher exact test, and Wilcoxon signed rank test.

RESULTS:

The most common indications for peritoneovenous shunt placement were metastatic disease or cirrhosis. In the shunt cohort, there were no significant differences in the aggregate psoas muscle area (13.4 vs 14.0 cm2; P = .223) or paraspinal muscle area (43.0 vs 42.2 cm2; P = .471). In the paracentesis cohort, there were significant decreases in aggregate psoas (18.1 vs 15.7 cm2; P < .0001) and erector spinae (43.4 vs 39.9 cm2; P < .0001) muscle area. In addition, there was a significant decrease in serum albumin level (3.2 vs 3.0 g/dL; P = .015) and Eastern Cooperative Oncology Group performance status score (1.0 vs 1.3; P < .0001) in the paracentesis group, compared with no significant changes in the shunt cohort.

CONCLUSIONS:

In patients with refractory ascites who are not candidates for transjugular intrahepatic portosystemic shunt placement, peritoneovenous shunt mitigates loss of truncal muscle and, in some instances, promotes muscle growth.

• Authors: Brian M Currie, Mina Bakhtiar, Gregory J Nadolski, Michael C Soulen
• Journal: Journal of vascular and interventional radiology : JVIR (J Vasc Interv Radiol) Vol. 34 Issue 4 Pg. 633-638 (04 2023) ISSN: 1535-7732 [Electronic] United States
• PMID: 36563934 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 SIR. Published by Elsevier Inc. All rights reserved.

Topics

• Humans
• Ascites (diagnostic imaging, etiology, therapy)
• Retrospective Studies
• Sarcopenia (diagnostic imaging, etiology)
• Peritoneovenous Shunt (adverse effects, methods)
• Liver Cirrhosis (complications, diagnostic imaging, surgery)
• Psoas Muscles (diagnostic imaging)
• Portasystemic Shunt, Transjugular Intrahepatic (adverse effects)