Calibrated portacaval H-graft shunt in variceal hemorrhage. Long-term results.
OBJECTIVE
To analyze the long-term outcome of the calibrated portacaval shunt in the treatment of portal hypertension.


METHODS
Between 1991 and 1996 we undertook a prospective non-randomized study, including 37 cirrhotic patients who underwent small diameter portacaval shunt with polytetrafluoroethylene H-graft, 24 cases with 8 mm and 13 cases with 10 mm. Early and late complications, and survival were analyzed.


RESULTS
Overall, 28 corresponded to Child-Pugh class A, 5 to class B and 4 to class C. The cause of cirrhosis was alcoholic in 16 cases, postnecrotic in 12, mixed in 5, primary biliary cirrhosis in 2 and unknown in 1. Postoperative mortality was 10%. Long-term results, after a follow-up of 3-8 years, have shown a rebleeding rate of 12%, mainly after the third postoperative year. Some degree of encephalopathy occurred in 23% of the patients, but in no case was this chronic or incapacitating. The rate of early thrombosis was 5%, but in all cases it was repermeabilized with local thrombolysis. The late thrombosis rate was 6%. The 3-, 5- and 7-year survival rates were 79%, 57%, and 36%, respectively. These rates were not statistically related with the shunt diameter or the etiology of the cirrhosis.


CONCLUSIONS
Partial portacaval shunt is a safe option for the treatment of variceal bleeding due to portal hypertension. We consider it to be the treatment of choice in a selected group of cirrhotic patients with well-preserved liver function, after previous failure of medical therapy. Furthermore, it can also be used as a bridge until liver transplantation.
Fernandez-Aguilar
Jose Luis
JL
Department of General and Digestive Surgery, Unit of Hepato-biliary Surgery and Liver Transplantation, Carlos Haya Regional University Hospital, Av. Carlos Haya s/n 29010, Malaga, Spain. jlfaguilar@inicia.es
Bondia Navarro
Jose Antonio
JA
Santoyo Santoyo
Julio
J
Suarez-Muñoz
Miguel Angel
MA
Perez-Daga
Antonio
A
Ramirez Plaza
Cesar
C
Mera Velasco
Santiago
S
de la Fuente Perucho
Agustin
A
D000328:Adult; D000368:Aged; D001807:Blood Vessel Prosthesis; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000401:mortality; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology / Q000601:surgery*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011167:Portacaval Shunt, Surgical / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D017755:Prosthesis Fitting / Q000379:methods; D016019:Survival Analysis
D011138:Polytetrafluoroethylene