Prospective study of a prosthetic H-graft portacaval shunt.
This study was undertaken to prospectively evaluate the 8-mm Gore-Tex interposition H-graft portacaval shunt. Thirty-six high-risk patients at the University of South Florida-affiliated hospitals received small-diameter shunts because of bleeding esophagogastric varices over a recent 2-year period. Portal vein and portal vein-inferior vena cava gradients were significantly reduced after shunting. These pressure changes were manifested clinically by the absence of variceal rebleeding and improvement of ascites; in addition, the incidence of encephalopathy was low. The 8-mm graft maintained hepatopedal flow in 67% of the patients, but reversal of flow did not result in complications commonly associated with poor portal perfusion. Graft thrombosis occurred in four (11%) patients. All grafts were successfully revised, three by operative revision and one by an interventional radiologist. Operative mortality was low (11%), and morbidity was unusual. The small-diameter H-graft portacaval shunt is a safe and effective method of treatment for bleeding esophagogastric varices.
Rosemurgy
A S
AS
Department of Surgery, University of South Florida, Tampa.
McAllister
E W
EW
Kearney
R E
RE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011167:Portacaval Shunt, Surgical / Q000295:instrumentation*; D011169:Portal Vein / Q000503:physiopathology; D011183:Postoperative Complications; D011446:Prospective Studies; D013927:Thrombosis / Q000209:etiology; D014682:Vena Cava, Inferior / Q000503:physiopathology; D014690:Venous Pressure
D011138:Polytetrafluoroethylene