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Calibrated portacaval H-graft shunt in variceal hemorrhage. Long-term results.
Hepatogastroenterology. 2003 Nov-Dec; 50(54):2000-4.H

Abstract

BACKGROUND/AIMS

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

METHODOLOGY

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.

Authors+Show Affiliations

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.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

14696452

Citation

Fernandez-Aguilar, Jose Luis, et al. "Calibrated Portacaval H-graft Shunt in Variceal Hemorrhage. Long-term Results." Hepato-gastroenterology, vol. 50, no. 54, 2003, pp. 2000-4.
Fernandez-Aguilar JL, Bondia Navarro JA, Santoyo Santoyo J, et al. Calibrated portacaval H-graft shunt in variceal hemorrhage. Long-term results. Hepatogastroenterology. 2003;50(54):2000-4.
Fernandez-Aguilar, J. L., Bondia Navarro, J. A., Santoyo Santoyo, J., Suarez-Muñoz, M. A., Perez-Daga, A., Ramirez Plaza, C., Mera Velasco, S., & de la Fuente Perucho, A. (2003). Calibrated portacaval H-graft shunt in variceal hemorrhage. Long-term results. Hepato-gastroenterology, 50(54), 2000-4.
Fernandez-Aguilar JL, et al. Calibrated Portacaval H-graft Shunt in Variceal Hemorrhage. Long-term Results. Hepatogastroenterology. 2003 Nov-Dec;50(54):2000-4. PubMed PMID: 14696452.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Calibrated portacaval H-graft shunt in variceal hemorrhage. Long-term results. AU - Fernandez-Aguilar,Jose Luis, AU - Bondia Navarro,Jose Antonio, AU - Santoyo Santoyo,Julio, AU - Suarez-Muñoz,Miguel Angel, AU - Perez-Daga,Antonio, AU - Ramirez Plaza,Cesar, AU - Mera Velasco,Santiago, AU - de la Fuente Perucho,Agustin, PY - 2003/12/31/pubmed PY - 2004/6/16/medline PY - 2003/12/31/entrez SP - 2000 EP - 4 JF - Hepato-gastroenterology JO - Hepatogastroenterology VL - 50 IS - 54 N2 - BACKGROUND/AIMS: To analyze the long-term outcome of the calibrated portacaval shunt in the treatment of portal hypertension. METHODOLOGY: 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. SN - 0172-6390 UR - https://www.unboundmedicine.com/medline/citation/14696452/Calibrated_portacaval_H_graft_shunt_in_variceal_hemorrhage__Long_term_results_ L2 - https://medlineplus.gov/cirrhosis.html DB - PRIME DP - Unbound Medicine ER -