Document Detail


Small-diameter prosthetic H-graft portacaval shunt: definitive therapy for variceal bleeding.
MedLine Citation:
PMID:  10457318     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Partial portal decompression has become a popular option in the treatment of complicated portal hypertension. This study was undertaken to report long-term follow-up after partial portal decompression obtained utilizing 8 mm prosthetic H-graft portacaval shunts. A total of 110 consecutive patients underwent H-graft portacaval shunting through a protocol that detailed care and studies from 1988 to 1996. Prospective follow-up recorded efficacy of partial portal decompression, shunt patency, morbidity of shunting, and survival. Seventy males and 40 females, whose average age was 54 +/-12.7 years (standard deviation), underwent shunting. Cirrhosis was due to alcohol abuse in 64%. Fourteen percent were in Child's class A, 55% in Child's class B, and 31% in Child's class C. Shunts were undertaken as emergencies in 20%, urgently in 13%, and electively in 67%. Shunting decreased portal pressure in all patients (30 +/-5.3 Hg to 19.9 -/+5.5 mm Hg; P <0.001). Early and late thrombosis was 6.4% and 3.6%, respectively. Late rebleeding occurred in 5.4%. Perioperative (30-day) mortality was 11.8%, and was highest for patients in Child's class C. Three-year survival was 53%. Five-year survival was 41%. Partial portal decompression is achieved with H-graft portacaval shunting. Rebleeding, shunt occlusion, and encephalopathy are uncommon. In this series of unselected older patients with alcoholic cirrhosis, 5-year survival after H-graft portacaval shunting was greater than 40% with minimal intervention.
Authors:
A S Rosemurgy; F M Serafini; E E Zervos; S E Goode
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract     Volume:  2     ISSN:  1091-255X     ISO Abbreviation:  J. Gastrointest. Surg.     Publication Date:    1998 Nov-Dec
Date Detail:
Created Date:  1999-10-07     Completed Date:  1999-10-07     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9706084     Medline TA:  J Gastrointest Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  585-91     Citation Subset:  IM    
Affiliation:
Division of Surgical Digestive Disorders, Tampa General Hospital, Department of Surgery, University of South Florida College of Medicine 33601, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Blood Vessel Prosthesis Implantation
Esophageal and Gastric Varices / complications*,  etiology
Female
Gastrointestinal Hemorrhage / etiology,  surgery*
Humans
Liver Cirrhosis, Alcoholic / complications*
Male
Middle Aged
Portacaval Shunt, Surgical*
Postoperative Complications
Prospective Studies
Survival Rate
Treatment Outcome

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


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