title: Does the direction of portal blood flow determine outcome with small-diameter prosthetic H-graft portacaval shunt?
abstract: BACKGROUND
  Partial portal decompression, as attained by small-diameter prosthetic H-graft portacaval shunting, continues to gain popularity because of favorable outcomes. This study was undertaken to determine whether the direction of preshunt or postshunt portal blood flow or reversal in the direction of portal flow occurred with shunting effect outcome after small-diameter prosthetic H-graft portacaval shunt.
  
  
  METHODS
  In 56 consecutive patients the direction of portal flow was determined before and after shunting. The direction of portal blood flow before and after shunting and changes in the direction of portal flow that occur with shunting were correlated with 30-day and 1-year survival, as well as with the rate of postshunt encephalopathy.
  
  
  RESULTS
  Portal pressures significantly decreased in all with shunting. Whether or not stratified by Child's classification, neither the preshunt nor postshunt direction of portal flow affected 30-day or 1-year survival or incidence of encephalopathy. Eleven patients (significant at p < 0.001, fisher's exact test) had reversal of portal blood flow with shunting without an increase in 30-day or 1-year survival or incidence of encephalopathy.
  
  
  CONCLUSIONS
  Small-diameter prosthetic H-graft portacaval shunts significantly reduce portal pressure and lead to reversal of portal flow in significant numbers. Significant hepatic dysfunction is uncommon after shunting. Neither the direction of preshunt or postshunt portal blood flow nor the reversal of portal blood flow with shunting has an effect on clinical outcome after small-diameter prosthetic H-graft portacaval shunt.
authors.affiliation: Department of Surgery, University of South Florida, Tampa, USA.
authors.forename: A S
authors.initials: AS
authors.lastname: Rosemurgy
authors.forename: J G
authors.initials: JG
authors.lastname: Norman
authors.forename: S E
authors.initials: SE
authors.lastname: Goode
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001807:Blood Vessel Prosthesis; D004867:Equipment Design; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical; D011168:Portal System / Q000503:physiopathology*; D011183:Postoperative Complications; D011184:Postoperative Period; D011446:Prospective Studies; D012039:Regional Blood Flow; D016019:Survival Analysis; D016896:Treatment Outcome