Arterialization of the Portal Vein in Conjunction with a Therapeutic Portacaval Shunt Hemodynamic Investigations and Results in 75 Patients

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Abstract
Cirrhotic patients (75) were submitted to peroperative hemodynamic investigations including flow and pressure studies. Patients (62) with a hepatopedal portal flow underwent a therapeutic end-to-side portacaval shunt (PC) in conjunction with arterialization of the portal vein, and patients 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 < 0.05) in emergency between arterialized (14.8%) and nonarterialized patients (62.5%). When the study ended, on July 15, 1981, the follow-up was > 2 yr for all the patients. The 5-yr 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%. Arterialization apparently is a safe surgical procedure that could be beneficial in respect with operative mortality in emergency, late survival and tolerence to portacaval shunt. A prospective randomized study such as the one undertaken in Dec. 1979 is the only method to prove clearly that arterialization is able to minimize the risk of encephalopathy and prolong the long-term survival after portacaval shunt.