Arterialization of the portal vein in conjunction with a therapeutic portacaval shunt. Hemodynamic investigations and results in 75 patients

Abstract

Seventy-five cirrhotic patients were submitted to peroperative hemodynamic investigations including flow and pressure studies. Sixty-two patients with hepatopedal portal flow underwent a therapeutic end-to-site portacaval shunt (PC) in conjunction with arterialization of the portal vein and 13 with a stagnant flow a PC shunt alone. Thirty-five patients were operated on in emergency and 40 electively. In 61 patients portal flow was correlated with maximum perfusion pressure (r=0.66), and in 33 patients with the reduction of corrected sinusoidal pressure induced by the occlusion of the portal vein (r=0.72). Operative mortality, which was 3.5% for 57 class A and B patients and 55.5% for 18 class C patients, differed significantly (p less than 0.05) in emergency between arterialized (14.8%) and nonarterialized patients (62.5%). At the time this study was ended on July 15, 1981, the follow-up was over two years for all the patients. The five-year actuarial survival rate of the arterialized patients was 48% for the whole group and 56% for class A and B patients; the overall incidence of chronic encephalopathy was 20%. It is concluded that arterialization is a safe surgical procedure that could be beneficial in respect with operative mortality in emergency, late survival, and tolerance to portacaval shunt. However, a prospective randomized study such as the one undertaken in December 1979 is the only method to prove clearly that arterialization is really able to minimize the risk of encephalopathy and to prolong the long-term survival after portacaval shunt.