Narrow-diameter portacaval shunts for management of variceal bleeding.
Over the past decade, we have developed and refined a method for partial portosystemic shunting for the control of bleeding esophageal varices in alcoholic cirrhotic patients. The narrow-diameter interposition portacaval H-graft using 8 mm polytetrafluoroethylene has been performed in 32 patients at our institution with low operative mortality (6.3%) and nearly complete cessation of variceal bleeding (96.7%) over a mean follow-up period of 43 months. In comparison with total shunts, diminished rates of postshunt encephalopathy (13% versus 40%) have been observed. Prograde portal blood flow has been preserved in 90% of 30 patients studied by perioperative portography. Shunt patency with continued prograde flow has been demonstrated at up to 9 years of follow-up. Investigators at three other centers have studied partial shunting using substantially similar techniques, with similar findings. Based on these results, we conclude that narrow-diameter shunts provide effective, long-lasting treatment for variceal hemorrhage due to portal hypertension in the alcoholic.
Collins
J C
JC
Surgical Service (112), Veterans Affairs Medical Center, Long Beach, California 90822.
Rypins
E B
EB
Sarfeh
I J
IJ
D001807:Blood Vessel Prosthesis; D004932:Esophageal and Gastric Varices / Q000401:mortality / Q000601:surgery*; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000401:mortality / Q000601:surgery*; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000601:surgery; D011138:Polytetrafluoroethylene; D011167:Portacaval Shunt, Surgical / Q000379:methods*; D011474:Prosthesis Design; D012008:Recurrence; D015996:Survival Rate
D011138:Polytetrafluoroethylene