Direction or Reversal of Preshunt Portal Blood Flow as Determinants of Outcome up to 1 Year after Small-Diameter Prosthetic H-Graft Portacaval Shunt
Autor: | Earl W. McAllister, Alexander S. Rosemurgy, Sarah E. Goode |
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Rok vydání: | 1995 |
Předmět: |
medicine.medical_specialty
Hemodynamics Portacaval shunt Surgical anastomosis Postoperative Complications Blood vessel prosthesis Hypertension Portal medicine Humans Prospective Studies Hepatic encephalopathy Aged Ultrasonography Portacaval Shunt Surgical business.industry Vascular disease Middle Aged medicine.disease Blood Vessel Prosthesis Surgery Shunting Portal System Treatment Outcome Regional Blood Flow Hepatic Encephalopathy Portal hypertension business |
Zdroj: | Journal of Surgical Research. 58:432-434 |
ISSN: | 0022-4804 |
DOI: | 10.1006/jsre.1995.1067 |
Popis: | Partial portal decompression (PPD) is gaining popularity in the treatment of portal hypertension. We have achieved PPD in over 80 patients by utilizing an 8-mm prosthetic H-graft portacaval shunt (HGPCS). We have been pleased with the infrequency of encephalopathy and liver failure after shunting. While maintenance of portal blood flow would presumably play a role in outcome after shunting, changes in portal hemodynamic occurring within the first year after shunting are generally unknown. In 31 patients (Child's class 6% A, 61% B, 32% C) of an average age of 55 ± 13.3 (SD) years undergoing HGPCS, clinical outcome was prospectively evaluated relative to the direction of portal blood flow determined before and after shunting and at 1 year after shunting using color-flow Doppler ultrasound. Preshunt hepatopetal flow reversed in 2/29 (7%) patients with shunting and in an additional 5/27 (18%) patients by 1 year after shunting. Death (due to alcoholism in 1, old age in 1) and encephalopathy (Child's class A = 1, B = 2, C = 1) were uncommon by 1 year after shunting. Eighty-one percent had excellent outcome (alive without encephalopathy or rebleeding) at 1 year. Though preshunt hepatopetal flow is generally maintained postshunt and after one year, maintenance of hepatopetal flow does not ensure an excellent outcome and reversal of hepatopetal flow does not predispose to a suboptimal outcome. Outcome up to 1 year after HGPCS is not determined by direction or reversal of portal blood flow. |
Databáze: | OpenAIRE |
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