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Small-diameter prosthetic H-graft portacaval shunt: definitive therapy for variceal bleeding.
J Gastrointest Surg. 1998 Nov-Dec; 2(6):585-91.JG

Abstract

Partial portal decompression has become a popular option in the treatment of complicated portal hypertension. This study was undertaken to report long-term follow-up after partial portal decompression obtained utilizing 8 mm prosthetic H-graft portacaval shunts. A total of 110 consecutive patients underwent H-graft portacaval shunting through a protocol that detailed care and studies from 1988 to 1996. Prospective follow-up recorded efficacy of partial portal decompression, shunt patency, morbidity of shunting, and survival. Seventy males and 40 females, whose average age was 54 +/-12.7 years (standard deviation), underwent shunting. Cirrhosis was due to alcohol abuse in 64%. Fourteen percent were in Child's class A, 55% in Child's class B, and 31% in Child's class C. Shunts were undertaken as emergencies in 20%, urgently in 13%, and electively in 67%. Shunting decreased portal pressure in all patients (30 +/-5.3 Hg to 19.9 -/+5.5 mm Hg; P <0.001). Early and late thrombosis was 6.4% and 3.6%, respectively. Late rebleeding occurred in 5.4%. Perioperative (30-day) mortality was 11.8%, and was highest for patients in Child's class C. Three-year survival was 53%. Five-year survival was 41%. Partial portal decompression is achieved with H-graft portacaval shunting. Rebleeding, shunt occlusion, and encephalopathy are uncommon. In this series of unselected older patients with alcoholic cirrhosis, 5-year survival after H-graft portacaval shunting was greater than 40% with minimal intervention.

Authors+Show Affiliations

Division of Surgical Digestive Disorders, Tampa General Hospital, Department of Surgery, University of South Florida College of Medicine 33601, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10457318

Citation

Rosemurgy, A S., et al. "Small-diameter Prosthetic H-graft Portacaval Shunt: Definitive Therapy for Variceal Bleeding." Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, vol. 2, no. 6, 1998, pp. 585-91.
Rosemurgy AS, Serafini FM, Zervos EE, et al. Small-diameter prosthetic H-graft portacaval shunt: definitive therapy for variceal bleeding. J Gastrointest Surg. 1998;2(6):585-91.
Rosemurgy, A. S., Serafini, F. M., Zervos, E. E., & Goode, S. E. (1998). Small-diameter prosthetic H-graft portacaval shunt: definitive therapy for variceal bleeding. Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, 2(6), 585-91.
Rosemurgy AS, et al. Small-diameter Prosthetic H-graft Portacaval Shunt: Definitive Therapy for Variceal Bleeding. J Gastrointest Surg. 1998 Nov-Dec;2(6):585-91. PubMed PMID: 10457318.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Small-diameter prosthetic H-graft portacaval shunt: definitive therapy for variceal bleeding. AU - Rosemurgy,A S, AU - Serafini,F M, AU - Zervos,E E, AU - Goode,S E, PY - 1999/8/24/pubmed PY - 1999/8/24/medline PY - 1999/8/24/entrez SP - 585 EP - 91 JF - Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract JO - J Gastrointest Surg VL - 2 IS - 6 N2 - Partial portal decompression has become a popular option in the treatment of complicated portal hypertension. This study was undertaken to report long-term follow-up after partial portal decompression obtained utilizing 8 mm prosthetic H-graft portacaval shunts. A total of 110 consecutive patients underwent H-graft portacaval shunting through a protocol that detailed care and studies from 1988 to 1996. Prospective follow-up recorded efficacy of partial portal decompression, shunt patency, morbidity of shunting, and survival. Seventy males and 40 females, whose average age was 54 +/-12.7 years (standard deviation), underwent shunting. Cirrhosis was due to alcohol abuse in 64%. Fourteen percent were in Child's class A, 55% in Child's class B, and 31% in Child's class C. Shunts were undertaken as emergencies in 20%, urgently in 13%, and electively in 67%. Shunting decreased portal pressure in all patients (30 +/-5.3 Hg to 19.9 -/+5.5 mm Hg; P <0.001). Early and late thrombosis was 6.4% and 3.6%, respectively. Late rebleeding occurred in 5.4%. Perioperative (30-day) mortality was 11.8%, and was highest for patients in Child's class C. Three-year survival was 53%. Five-year survival was 41%. Partial portal decompression is achieved with H-graft portacaval shunting. Rebleeding, shunt occlusion, and encephalopathy are uncommon. In this series of unselected older patients with alcoholic cirrhosis, 5-year survival after H-graft portacaval shunting was greater than 40% with minimal intervention. SN - 1091-255X UR - https://www.unboundmedicine.com/medline/citation/10457318/Small_diameter_prosthetic_H_graft_portacaval_shunt:_definitive_therapy_for_variceal_bleeding_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1091-255X(98)80061-9 DB - PRIME DP - Unbound Medicine ER -