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Partial portacaval shunt for variceal hemorrhage: longitudinal analysis of effectiveness.
Arch Surg. 1998 Jun; 133(6):590-2; discussion 592-4.AS

Abstract

OBJECTIVE

To determine rates of survival, long-term patency, and recurrent variceal hemorrhage among patients with alcoholic cirrhosis treated by partial portacaval shunt.

DESIGN

Single-institution cohort follow-up study of 72 consecutive patients who underwent small-diameter portacaval H-graft shunt with collateral ablation during a 10-year period (1981 through 1990). Subjects were enrolled and followed up for up to 15 years. Shunt patency was assessed by portography and/or ultrasonography. We performed 7-year Kaplan-Meier analyses of survival (in 65 patients in Child classes A and B), shunt patency, and absence of variceal bleeding.

SETTING

Tertiary academic referral center of the US Department of Veterans Affairs.

PATIENTS

Patients with alcoholic cirrhosis were considered for operation after at least 1 proven episode of variceal hemorrhage. Patients with portal vein thrombosis were excluded; patients in Child class C underwent operation only for compelling indications. Of the 72 who underwent partial shunting, 38 were in Child class A, 27 were in class B, and 7 were in class C.

INTERVENTIONS

Partial portacaval shunt (6-, 8- or 10-mm polytetrafluoroethylene H-graft with collateral ablation) and serial follow-up.

MAIN OUTCOME MEASURES

Study end points were death, recurrent variceal hemorrhage, and unavailability for follow-up. Other measures included graft patency and nonvariceal rebleeding.

RESULTS

Cumulative probability of 7-year patency for grafts at risk was 95%. The 7-year probability for absence of variceal bleeding in patients at risk was 92%. In 65 patients in Child classes A and B, operative mortality was 7.7% and the cumulative probability of 7-year survival was 54%.

CONCLUSION

For variceal bleeding associated with alcoholic cirrhosis, the small-diameter polytetrafluoroethylene portacaval H-graft with collateral ablation affords durable patency and protection against variceal rebleeding.

Authors+Show Affiliations

Surgical Service, Long Beach Veterans Affairs Medical Center, Calif, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9637455

Citation

Collins, J C., et al. "Partial Portacaval Shunt for Variceal Hemorrhage: Longitudinal Analysis of Effectiveness." Archives of Surgery (Chicago, Ill. : 1960), vol. 133, no. 6, 1998, pp. 590-2; discussion 592-4.
Collins JC, Ong MJ, Rypins EB, et al. Partial portacaval shunt for variceal hemorrhage: longitudinal analysis of effectiveness. Arch Surg. 1998;133(6):590-2; discussion 592-4.
Collins, J. C., Ong, M. J., Rypins, E. B., & Sarfeh, I. J. (1998). Partial portacaval shunt for variceal hemorrhage: longitudinal analysis of effectiveness. Archives of Surgery (Chicago, Ill. : 1960), 133(6), 590-2; discussion 592-4.
Collins JC, et al. Partial Portacaval Shunt for Variceal Hemorrhage: Longitudinal Analysis of Effectiveness. Arch Surg. 1998;133(6):590-2; discussion 592-4. PubMed PMID: 9637455.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Partial portacaval shunt for variceal hemorrhage: longitudinal analysis of effectiveness. AU - Collins,J C, AU - Ong,M J, AU - Rypins,E B, AU - Sarfeh,I J, PY - 1998/6/24/pubmed PY - 1998/6/24/medline PY - 1998/6/24/entrez SP - 590-2; discussion 592-4 JF - Archives of surgery (Chicago, Ill. : 1960) JO - Arch Surg VL - 133 IS - 6 N2 - OBJECTIVE: To determine rates of survival, long-term patency, and recurrent variceal hemorrhage among patients with alcoholic cirrhosis treated by partial portacaval shunt. DESIGN: Single-institution cohort follow-up study of 72 consecutive patients who underwent small-diameter portacaval H-graft shunt with collateral ablation during a 10-year period (1981 through 1990). Subjects were enrolled and followed up for up to 15 years. Shunt patency was assessed by portography and/or ultrasonography. We performed 7-year Kaplan-Meier analyses of survival (in 65 patients in Child classes A and B), shunt patency, and absence of variceal bleeding. SETTING: Tertiary academic referral center of the US Department of Veterans Affairs. PATIENTS: Patients with alcoholic cirrhosis were considered for operation after at least 1 proven episode of variceal hemorrhage. Patients with portal vein thrombosis were excluded; patients in Child class C underwent operation only for compelling indications. Of the 72 who underwent partial shunting, 38 were in Child class A, 27 were in class B, and 7 were in class C. INTERVENTIONS: Partial portacaval shunt (6-, 8- or 10-mm polytetrafluoroethylene H-graft with collateral ablation) and serial follow-up. MAIN OUTCOME MEASURES: Study end points were death, recurrent variceal hemorrhage, and unavailability for follow-up. Other measures included graft patency and nonvariceal rebleeding. RESULTS: Cumulative probability of 7-year patency for grafts at risk was 95%. The 7-year probability for absence of variceal bleeding in patients at risk was 92%. In 65 patients in Child classes A and B, operative mortality was 7.7% and the cumulative probability of 7-year survival was 54%. CONCLUSION: For variceal bleeding associated with alcoholic cirrhosis, the small-diameter polytetrafluoroethylene portacaval H-graft with collateral ablation affords durable patency and protection against variceal rebleeding. SN - 0004-0010 UR - https://www.unboundmedicine.com/medline/citation/9637455/Partial_portacaval_shunt_for_variceal_hemorrhage:_longitudinal_analysis_of_effectiveness_ L2 - https://jamanetwork.com/journals/jamasurgery/fullarticle/vol/133/pg/590 DB - PRIME DP - Unbound Medicine ER -