Calibrated portacaval H-graft shunt in variceal hemorrhage. Long-term results

• Published in: Hepato-gastroenterology Vol. 50; no. 54; p. 2000
• Main Authors: Fernandez-Aguilar, Jose Luis, Bondia Navarro, Jose Antonio, Santoyo Santoyo, Julio, Suarez-Muñoz, Miguel Angel, Perez-Daga, Antonio, Ramirez Plaza, Cesar, Mera Velasco, Santiago, de la Fuente Perucho, Agustin
• Format: Journal Article
• Language: English
• Published: Greece 01.11.2003
• Subjects: Adult; Aged; Blood Vessel Prosthesis; Esophageal and Gastric Varices - surgery; Female; Follow-Up Studies; Gastrointestinal Hemorrhage - surgery; Graft Occlusion, Vascular - etiology; Graft Occlusion, Vascular - mortality; Hepatic Encephalopathy - etiology; Hepatic Encephalopathy - mortality; Hospital Mortality; Humans; Liver Cirrhosis - etiology; Liver Cirrhosis - surgery; Liver Function Tests; Male; Middle Aged; Polytetrafluoroethylene; Portacaval Shunt, Surgical - methods; Postoperative Complications - etiology; Postoperative Complications - mortality; Prosthesis Fitting - methods; Survival Analysis
• ISSN: 0172-6390

To analyze the long-term outcome of the calibrated portacaval shunt in the treatment of portal hypertension. 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. 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. 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.