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Collateral ablation improves portal perfusion after partial portacaval shunt.
Am Surg. 1995 Oct; 61(10):868-73.AS

Abstract

Small-diameter portacaval H-grafts (partial shunts) effectively abolish bleeding from esophageal varices. Goals are 1) to prevent variceal hemorrhage by subtotal portal decompression, and 2) to minimize postshunt encephalopathy by maintaining substantial residual pressure and prograde flow in the portal vein. To reduce spontaneous shunting of portal blood away from the liver, we advocate ablation of collateral vessels after partial shunts. Others have performed partial shunts without collateral ablation. We postulated that ablation of collateral vessels would augment portal perfusion pressure and preserve prograde portal flow after partial shunts. In 15 patients undergoing 8 or 10 mm portacaval H-grafts, portal pressure was measured intraoperatively before and after ligation of principal venous collaterals. In another 13 patients, collateral embolization was performed during postoperative portography. The degree of portal perfusion was scored. Pressure measurements demonstrated a mean rise in portal pressure of 2.8 cm saline after ligation (P = 0.025). Angiographic perfusion scores after embolization improved by a mean of 0.57 points on a 4 point scale (P = 0.032). We conclude that intraoperative collateral ligation augments residual portal pressures and that postoperative collateral embolization improves portal flow patterns. Since both observed effects have been associated with decreased postshunt encephalopathy rates, ablation of collateral vessels must be an integral component of the partial portacaval shunt.

Authors+Show Affiliations

Collins JC
Veterans Affairs Medical Center, Long Beach, USA.
Conroy RM
No affiliation info available
Sarfeh IJ
No affiliation info available

MeSH

ConstrictionEmbolization, TherapeuticEsophageal and Gastric VaricesGastrointestinal HemorrhageHemodynamicsHumansIntraoperative PeriodLigationMalePortacaval Shunt, SurgicalPortal Pressure

Pub Type(s)

Journal Article

Language

eng

PubMed ID

7668459

Citation

Collins, J C., et al. "Collateral Ablation Improves Portal Perfusion After Partial Portacaval Shunt." The American Surgeon, vol. 61, no. 10, 1995, pp. 868-73.
Collins JC, Conroy RM, Sarfeh IJ. Collateral ablation improves portal perfusion after partial portacaval shunt. Am Surg. 1995;61(10):868-73.
Collins, J. C., Conroy, R. M., & Sarfeh, I. J. (1995). Collateral ablation improves portal perfusion after partial portacaval shunt. The American Surgeon, 61(10), 868-73.
Collins JC, Conroy RM, Sarfeh IJ. Collateral Ablation Improves Portal Perfusion After Partial Portacaval Shunt. Am Surg. 1995;61(10):868-73. PubMed PMID: 7668459.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Collateral ablation improves portal perfusion after partial portacaval shunt. AU - Collins,J C, AU - Conroy,R M, AU - Sarfeh,I J, PY - 1995/10/1/pubmed PY - 1995/10/1/medline PY - 1995/10/1/entrez SP - 868 EP - 73 JF - The American surgeon JO - Am Surg VL - 61 IS - 10 N2 - Small-diameter portacaval H-grafts (partial shunts) effectively abolish bleeding from esophageal varices. Goals are 1) to prevent variceal hemorrhage by subtotal portal decompression, and 2) to minimize postshunt encephalopathy by maintaining substantial residual pressure and prograde flow in the portal vein. To reduce spontaneous shunting of portal blood away from the liver, we advocate ablation of collateral vessels after partial shunts. Others have performed partial shunts without collateral ablation. We postulated that ablation of collateral vessels would augment portal perfusion pressure and preserve prograde portal flow after partial shunts. In 15 patients undergoing 8 or 10 mm portacaval H-grafts, portal pressure was measured intraoperatively before and after ligation of principal venous collaterals. In another 13 patients, collateral embolization was performed during postoperative portography. The degree of portal perfusion was scored. Pressure measurements demonstrated a mean rise in portal pressure of 2.8 cm saline after ligation (P = 0.025). Angiographic perfusion scores after embolization improved by a mean of 0.57 points on a 4 point scale (P = 0.032). We conclude that intraoperative collateral ligation augments residual portal pressures and that postoperative collateral embolization improves portal flow patterns. Since both observed effects have been associated with decreased postshunt encephalopathy rates, ablation of collateral vessels must be an integral component of the partial portacaval shunt. SN - 0003-1348 UR - https://www.unboundmedicine.com/medline/citation/7668459/Collateral_ablation_improves_portal_perfusion_after_partial_portacaval_shunt_ L2 - https://medlineplus.gov/gastrointestinalbleeding.html DB - PRIME DP - Unbound Medicine ER -