[Small-diameter portosystemic shunts: indications and limitations].
Low diameter porto-systemic shunts for the treatment of portal hypertension bleeding have emerged as a consequence of the technical development of vascular grafts (PTFE) that allow the use of a narrow lumen. The experience with this kind of operation at the Instituto Nacional de la Nutrición Salvador Zubirán, Mexico City during a 6-year period is reported. There were twenty-seven patients with good liver function (Child-Pugh A-B) were operated or electively, average Age 47.5 years (range 17-71), twenty three patients with liver cirrhosis, one with portal fibrosis and three with idiopathic portal hypertension. Operative mortality: 4%. Rebleeding: 14%. Postoperative encephalopathy was observed in 14 of 27, three of them being grade III-IV (11%). In the remaining 11 cases, it was mild and easily controlled. Postoperative angiography showed shunt patency in 81% of the cases; in 33% of the cases, portal vein diameter reduction was shown, as well as two cases with portal vein thrombosis. In 77% of the cases, adequate postoperative quality of life was observed. Survival (Kaplan-Meier): 86% at 12 months and 56% at 60 months. These kinds of shunts are a good alternate choice for patients considered for surgery, in which other portal blood flow preserving procedures (selective shunts, devascularization with transection) are not feasible.
Angel Mercado
M
M
Clínica de hipertensión portal, Instituto Nacional de la Nutrición Salvador Zubirán, México, D.F.
Granados-García
J
J
Barradas
F
F
Chan
C
C
Contreras
J L
JL
Orozco
H
H
Angel-Mercado
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000401:mortality / Q000601:surgery*; D008102:Liver Circulation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011138:Polytetrafluoroethylene; D011170:Portasystemic Shunt, Surgical / Q000401:mortality; D015996:Survival Rate; D013997:Time Factors
D011138:Polytetrafluoroethylene
Derivaciones portosistémicas de bajo diámetro. Indicaciones y limitaciones.