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Immediate and long-term portal hemodynamic consequences of small-diameter H-graft portacaval shunt.
J Surg Res. 1998 Jan; 74(1):71-5.JS

Abstract

BACKGROUND

Effective hepatic blood flow is thought to play a critical role in outcome following portal decompressive procedures. We have shown previously that hepatic arterialization occurs soon after shunting, preserving nutrient flow, but the remote effects of shunting are unknown. The purpose of this study was to determine the effect of small-diameter prosthetic H-graft portacaval shunt (HGPCS) on effective hepatic blood flow (EHF) and portal pressures 1 year from shunt placement.

METHODS

Patients undergoing 8-mm HGPCS had effective hepatic blood flow determined using low-dose galactose clearance preoperatively, postoperatively, and at 1 year postshunt. Portal blood flow, pressures, and portal vein/inferior vena cava pressure gradients were determined intraoperatively before and after shunt placement and at 1 year.

RESULTS

Twenty patients undergoing shunting had flows measured. All patients had significant reductions in portal vein/inferior vena cava pressure gradients while effective hepatic flow was maintained immediately postoperatively. At 1 year following shunting, effective hepatic blood flow was significantly lower than both pre- and postoperative rates of flow while portal pressures and gradients were significantly increased. Albumin, cholesterol, and PT were improved at 1 year while total bilirubin was slightly worse. Nineteen of 20 patients are still alive with average follow-up of 26 +/- 10.3 months. Four patients were encephalopathic preop, 5 postop, and none chronically.

CONCLUSIONS

Recollateralization of varices and progression of cirrhosis may account for the observed reductions in EHF at 1 year. Regardless of the cause, diminution of EHF at 1 year is well compensated as demonstrated by minimal encephalopathy and ascites, improved hepatic function reflected in blood chemistry profiles, and good survival.

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Authors+Show Affiliations

Zervos EE
Department of Surgery, College of Medicine, University of South Florida, Tampa 33606, USA.
Goode SE
No affiliation info available
Rosemurgy AS
No affiliation info available

MeSH

AdultAgedAscitesBlood Flow VelocityDecompression, SurgicalFemaleHemodynamicsHepatic EncephalopathyHumansHypertension, PortalLiver CirculationMaleMiddle AgedPortacaval Shunt, SurgicalPortal PressurePortal VeinTime FactorsVena Cava, Inferior

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9536977

Citation

Zervos, E E., et al. "Immediate and Long-term Portal Hemodynamic Consequences of Small-diameter H-graft Portacaval Shunt." The Journal of Surgical Research, vol. 74, no. 1, 1998, pp. 71-5.
Zervos EE, Goode SE, Rosemurgy AS. Immediate and long-term portal hemodynamic consequences of small-diameter H-graft portacaval shunt. J Surg Res. 1998;74(1):71-5.
Zervos, E. E., Goode, S. E., & Rosemurgy, A. S. (1998). Immediate and long-term portal hemodynamic consequences of small-diameter H-graft portacaval shunt. The Journal of Surgical Research, 74(1), 71-5.
Zervos EE, Goode SE, Rosemurgy AS. Immediate and Long-term Portal Hemodynamic Consequences of Small-diameter H-graft Portacaval Shunt. J Surg Res. 1998;74(1):71-5. PubMed PMID: 9536977.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Immediate and long-term portal hemodynamic consequences of small-diameter H-graft portacaval shunt. AU - Zervos,E E, AU - Goode,S E, AU - Rosemurgy,A S, PY - 1998/4/16/pubmed PY - 1998/4/16/medline PY - 1998/4/16/entrez SP - 71 EP - 5 JF - The Journal of surgical research JO - J Surg Res VL - 74 IS - 1 N2 - BACKGROUND: Effective hepatic blood flow is thought to play a critical role in outcome following portal decompressive procedures. We have shown previously that hepatic arterialization occurs soon after shunting, preserving nutrient flow, but the remote effects of shunting are unknown. The purpose of this study was to determine the effect of small-diameter prosthetic H-graft portacaval shunt (HGPCS) on effective hepatic blood flow (EHF) and portal pressures 1 year from shunt placement. METHODS: Patients undergoing 8-mm HGPCS had effective hepatic blood flow determined using low-dose galactose clearance preoperatively, postoperatively, and at 1 year postshunt. Portal blood flow, pressures, and portal vein/inferior vena cava pressure gradients were determined intraoperatively before and after shunt placement and at 1 year. RESULTS: Twenty patients undergoing shunting had flows measured. All patients had significant reductions in portal vein/inferior vena cava pressure gradients while effective hepatic flow was maintained immediately postoperatively. At 1 year following shunting, effective hepatic blood flow was significantly lower than both pre- and postoperative rates of flow while portal pressures and gradients were significantly increased. Albumin, cholesterol, and PT were improved at 1 year while total bilirubin was slightly worse. Nineteen of 20 patients are still alive with average follow-up of 26 +/- 10.3 months. Four patients were encephalopathic preop, 5 postop, and none chronically. CONCLUSIONS: Recollateralization of varices and progression of cirrhosis may account for the observed reductions in EHF at 1 year. Regardless of the cause, diminution of EHF at 1 year is well compensated as demonstrated by minimal encephalopathy and ascites, improved hepatic function reflected in blood chemistry profiles, and good survival. SN - 0022-4804 UR - https://www.unboundmedicine.com/medline/citation/9536977/Immediate_and_long_term_portal_hemodynamic_consequences_of_small_diameter_H_graft_portacaval_shunt_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-4804(97)95194-5 DB - PRIME DP - Unbound Medicine ER -