Long-term follow-up of distal splenorenal shunts: evaluation by arteriography, shuntography, transhepatic portal venography, and cinefluorography.

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Abstract
Patients [8] with patent distal splenorenal shunts [to correct episodes of profuse upper gastrointestinal bleeding from esophageal or gastric varices, associated with portal hypertension] were studied after a 22-36 mo. interval. Evolution of hemodynamic and anatomical changes was documented by percutaneous transhepatic portal catheterization, cinefluorography using ethiodized oil droplets, transfemoral splenorenal shuntography and celiac arteriography. Changes included the following: a decrease in the portosystemic venous pressure gradient; an increase in the size of and flow through both the shunt and the hepatic artery; reversal of portal venous flow; marked dilatation of collaterals and diversion of flow from the superior mesenteric vein to the shunt; and an increase in cardiac output.