Document Detail


Calibrated portacaval H-graft shunt in variceal hemorrhage. Long-term results.
MedLine Citation:
PMID:  14696452     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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:
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:
Type:  Journal Article    
Journal Detail:
Title:  Hepato-gastroenterology     Volume:  50     ISSN:  0172-6390     ISO Abbreviation:  Hepatogastroenterology     Publication Date:    2003 Nov-Dec
Date Detail:
Created Date:  2003-12-30     Completed Date:  2004-06-15     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8007849     Medline TA:  Hepatogastroenterology     Country:  Greece    
Other Details:
Languages:  eng     Pagination:  2000-4     Citation Subset:  IM    
Affiliation:
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:
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:
9002-84-0/Polytetrafluoroethylene

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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