| Calibrated portacaval H-graft shunt in variceal hemorrhage. Long-term results. | |
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MedLine Citation:
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PMID: 14696452 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Jose Luis Fernandez-Aguilar; Jose Antonio Bondia Navarro; Julio Santoyo Santoyo; Miguel Angel Suarez-Muñoz; Antonio Perez-Daga; Cesar Ramirez Plaza; Santiago Mera Velasco; Agustin de la Fuente Perucho |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Hepato-gastroenterology Volume: 50 ISSN: 0172-6390 ISO Abbreviation: Hepatogastroenterology Publication Date: 2003 Nov-Dec |
Date Detail:
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Created Date: 2003-12-30 Completed Date: 2004-06-15 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8007849 Medline TA: Hepatogastroenterology Country: Greece |
Other Details:
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Languages: eng Pagination: 2000-4 Citation Subset: IM |
Affiliation:
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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.es |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Blood Vessel Prosthesis* Esophageal and Gastric Varices / surgery* Female Follow-Up Studies Gastrointestinal Hemorrhage / surgery* Graft Occlusion, Vascular / etiology, mortality Hepatic Encephalopathy / etiology, mortality Hospital Mortality Humans Liver Cirrhosis / etiology, surgery* Liver Function Tests Male Middle Aged Polytetrafluoroethylene* Portacaval Shunt, Surgical / methods* Postoperative Complications / etiology, mortality Prosthesis Fitting / methods Survival Analysis |
| Chemical | |
Reg. No./Substance:
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9002-84-0/Polytetrafluoroethylene |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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