Small-diameter portacaval H-graft for variceal hemorrhage.
This report describes the steps in the development of the concept of partial shunting from its earliest stages to the 8-mm-diameter portacaval H-graft. Sequentially decreasing the diameter of the graft from 20 mm did not seem to affect hepatic hemodynamics until the 10-mm-diameter graft was used. At this point, we began to see some patients maintain prograde portal flow. Further reduction in diameter gave a higher rate of patients with prograde flow. Postoperative flow patterns correlate with lower encephalopathy rates and better long-term survival. Important nuances of the operative technique as well as pre- and postoperative management are described.
Rypins
E B
EB
University of California, Irvine.
Sarfeh
I J
IJ
D001807:Blood Vessel Prosthesis; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000601:surgery; D011167:Portacaval Shunt, Surgical / Q000379:methods*; D012008:Recurrence