INTERPOSITION MESOCAVAL SHUNT FOR CHRONIC PRIMARY OCCLUSION OF THE HEPATIC VEINS
- 1 January 1979
- journal article
- research article
- Vol. 148 (5) , 691-698
Abstract
Patients [5] with primitive chronic Budd-Chiari syndrome were treated by Dacron interposed mesocaval shunts for medically uncontrollable ascites. In 2 cases, hepatomegaly and ascites disappeared for 4 and 4 1/2 yr. In 1 patient with severe stenosis of the inferior vena cava, moderate ascites required tapping once a month 1 yr later, despite proved prosthesis patency. In 2 patients, death occurred 10 and 30 days after shunting due to graft thrombosis. Inferior vena cava stenosis appears to be the major factor for decision of opportunity and type of portacaval shunt. Three types of stenosis are described: type I, due to caudate lobe hypertrophy and type II, due to right lobe hypertrophy, are suitable for side-by-side portacaval or mesocaval shunts. Type III, regular and extended narrowing of inferior vena cava, seen in long term evolutive forms, is presumably due to fibrosis and is not a good indication for conventional infrahepatic shunting procedures. Another patient had a side-to-side portacaval anastomosis for chronic Budd-Chiari syndrome without caval stenosis. The patient was seen for 7 mo. and ascites did not reappear. A complete radiologic and hemodynamic preoperative study of inferior vena cava outflow impairment is important.This publication has 0 references indexed in Scilit: