Long-term patency of the mesocaval C shunt.
Reports of thrombosis rates as high as 40 percent with the mesocaval H shunt led us to review our results with the mesocaval C shunt in 33 consecutive patients. Their ages ranged from 23 to 69 years (mean 50 +/- 12 years). There were 21 male and 12 female patients. The causes of portal hypertension included alcoholic cirrhosis in 13 patients, primary biliary cirrhosis in 6 patients, postnecrotic cirrhosis in 6 patients, cryptogenic cirrhosis in 3 patients, the Budd-Chiari syndrome in 4 patients, and portal vein thrombosis in 1 patient. Twelve patients were in Child's class A, 8 were in Child's class B, and 13 were in Child's class C. Operative mortality was 24 percent (8 of 33 patients) but occurred only in class C patients under nonelective conditions. Shunt patency was determined by one or more of the following: autopsy, angiography, and a lack of recurrent varices or hemorrhage. Autopsies were performed in 12 patients from 1 week to 72 months after operation. All 12 C shunts were widely patent. Angiography was performed in 13 patients from 1 to 38 months postoperatively. All 13 C shunts were patent; however, 2 eventually stenosed and attempts at ballon angioplasty were only moderately successful. Follow-up to time of death or to date was possible in 24 of 25 survivors, and ranged from 3 to 123 months. Evidence of recurrent varices, variceal hemorrhage, or both developed in only two patients (2 of 24, 8 percent), both of whom had stenosed shunts.
D000328:Adult; D000368:Aged; D001201:Ascites / Q000150:complications; D004932:Esophageal and Gastric Varices / Q000150:complications; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000150:complications; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000601:surgery; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications; D012008:Recurrence; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors