Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1978 May;187(5):515–522. doi: 10.1097/00000658-197805000-00009

Results of interposition "H" grafts for portal hypertension.

B W Thompson, R E Casali, R C Read, G S Campbell
PMCID: PMC1396559  PMID: 306227

Abstract

During the past nine years, 54 patients underwent interposition graft shunting for variceal bleeding in 48 and intractable ascites in six, either electively (35 instances) or as an emergency (13 instances). Autogenous jugular was used in 41 instances, homologous vena cava in nine and Dacron in five. The interposition graft was placed between superior mesenteric vein and vena cava in 36 instances and the portal vein and vena cava in 19. Using Child's Clinical Classification 44 were Class C and 10 Class B. There were six (11%) operative deaths with one (2.4%) in the elective and five (38%) in the emergency group. Encephalopathy was seen in 4 (10%) of those surviving more than one year. Two Dacron and two homografts thrombosed. Eight of the autografts were patent at autopsy, 18 on angiography and 15 assumed to be patent because patients were asymptomatic. Only one of 12 late deaths was related to grafts failure. Apparently the operation controls ascites and the autogenous jugular vein is the ideal material. Interposition "H" grafting is a simple safe procedure that can be used for portal decompression in patients with bleeding varices.

Full text

PDF
515

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Betancourt J. R., Hirsh E. F., Estes J. T. Portacaval shunts: experimental use of various grafting materials constructing a "Y" shape shunt. Am Surg. 1969 Jul;35(7):516–524. [PubMed] [Google Scholar]
  2. Bismuth H., Franco D., Hepp J. Portal-systemic shunt in hepatic cirrhosis: does the type of shunt decisively influence the clinical result? Ann Surg. 1974 Feb;179(2):209–218. doi: 10.1097/00000658-197402000-00019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Blakemore A. H., Lord J. W. The Technic of Using Vitallium Tubes in Establishing Portacaval Shunts for Portal Hypertension. Ann Surg. 1945 Oct;122(4):476–489. doi: 10.1097/00000658-194510000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Burchell A. R., Moreno A. H., Panke W. F., Nealon T. F., Jr Hemodynamic variables and prognosis following portacaval shunts. Surg Gynecol Obstet. 1974 Mar;138(3):359–369. [PubMed] [Google Scholar]
  5. DALE W. A., SCOTT H. W., Jr Grafts of the venous system. Surgery. 1963 Jan;53:52–74. [PubMed] [Google Scholar]
  6. Drapanas T. Interposition mesocaval shunt for treatment of portal hypertension. Ann Surg. 1972 Oct;176(4):435–448. doi: 10.1097/00000658-197210000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Drapanas T., LoCicero J., 3rd, Dowling J. B. Hemodynamics of the interposition mesocaval shunt. Ann Surg. 1975 May;181(5):523–533. doi: 10.1097/00000658-197505000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Filtzer H. S., Rossi R., Wolfort F. G. Experience with interposition mesocaval shunt for management of variceal bleeding. Arch Surg. 1977 May;112(5):593–595. doi: 10.1001/archsurg.1977.01370050053008. [DOI] [PubMed] [Google Scholar]
  9. Fonkalsrud E. W., Linde L. M., Longmire W. P., Jr Portal hypertension from idiopathic superior vena caval obstruction. JAMA. 1966 Apr 11;196(2):129–132. [PubMed] [Google Scholar]
  10. Foster J. H., Jolly P. C., Symbas P. N., Dively W. L. Vein grafting in portal venous system. Arch Surg. 1965 Nov;91(5):716–724. doi: 10.1001/archsurg.1965.01320170010003. [DOI] [PubMed] [Google Scholar]
  11. GLIEDMAN M. L., MARGULIES M. THE SIDE-TO-END SUPERIOR MESENTERIC VEIN-INFERIOR VENA CAVA SHUNT FOR PORTAL DECOMPRESSION. Surgery. 1964 Sep;56:473–480. [PubMed] [Google Scholar]
  12. George P., Brown C., Ridgway G., Crofts B., Sherlock S. Emergency oesophageal transection in uncontrolled variceal haemorrhage. Br J Surg. 1973 Aug;60(8):635–640. doi: 10.1002/bjs.1800600815. [DOI] [PubMed] [Google Scholar]
  13. Giles G. R., Brennan T. G., Losowsky M. S. Interposition teflon mesenteric caval shunt for bleeding oesophageal varices. Br J Surg. 1973 Aug;60(8):649–652. doi: 10.1002/bjs.1800600818. [DOI] [PubMed] [Google Scholar]
  14. Harmon J. W., Zinner M. J., Reynolds D. G. Comparison of portal flow distribution after portacaval and mesocaval shunts. J Surg Res. 1977 Apr;22(4):343–347. doi: 10.1016/0022-4804(77)90154-8. [DOI] [PubMed] [Google Scholar]
  15. Holyoke E. A., Davis W. C., Harry R. D. Surgical anatomy of the mesocaval shunt. Surgery. 1975 Oct;78(4):526–530. [PubMed] [Google Scholar]
  16. Lord J. W., Jr, Rossi G., Daliana M., Rosati L. M. Mesocaval shunt modified by the use of a teflon prosthesis. Surg Gynecol Obstet. 1970 Mar;130(3):525–526. [PubMed] [Google Scholar]
  17. Lord J. W., Jr, Rossi G., Daliana M., Rosati L. M. Portasystemic shunts in the management of massive hemorrhage from esophageal varices due to cirrhosis of the liver. Am J Surg. 1971 Mar;121(3):241–248. doi: 10.1016/0002-9610(71)90197-8. [DOI] [PubMed] [Google Scholar]
  18. Luttwak E. M., Charuzi I., Licht A., Freund H., Borman J. B. Emergency splenic vein-right atrial shunt for massive esophageal hemorrhage with cirrhosis of liver and inferior vena cava occlusion: report of an operation and follow-up. Ann Surg. 1973 Apr;177(4):411–412. doi: 10.1097/00000658-197304000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. MACDONALD R. A. Primary carcinoma of the liver; a clinicopathologic study of one hundred eight cases. AMA Arch Intern Med. 1957 Feb;99(2):266–279. doi: 10.1001/archinte.1957.00260020102015. [DOI] [PubMed] [Google Scholar]
  20. MARION P. Traitement chirurgical de l'hypertension portale. Helv Med Acta. 1954 Oct;21(4-5):375–386. [PubMed] [Google Scholar]
  21. Mullane J. F., Gliedman M. L. Elevation of the pressure in the abdominal inferior vena cava as a cause of a hepatorenal syndrome in cirrhosis. Surgery. 1966 Jun;59(6):1135–1146. [PubMed] [Google Scholar]
  22. Nabseth D. C., O'Hara E. T., Marks L. J., Mehrez I. O. The "H graft" in portacaval shunts. Ann Surg. 1968 Aug;168(2):201–206. doi: 10.1097/00000658-196808000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Prandi D., Rueff B., Roche-Sicot J., Sicot C., Maillard J. N., Benhamou J. P., Fauvert R. Life-threatening hemorrhage of the digestive tract in cirrhotic patients. An assessment of the postoperative mortality after emergency portacaval shunt. Am J Surg. 1976 Feb;131(2):204–209. doi: 10.1016/0002-9610(76)90098-2. [DOI] [PubMed] [Google Scholar]
  24. Preston F. W., Trippel O. H. The technique of emergency portacaval shunt. Surg Clin North Am. 1966 Feb;46(1):37–53. doi: 10.1016/s0039-6109(16)37780-5. [DOI] [PubMed] [Google Scholar]
  25. Pugh R. N., Murray-Lyon I. M., Dawson J. L., Pietroni M. C., Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973 Aug;60(8):646–649. doi: 10.1002/bjs.1800600817. [DOI] [PubMed] [Google Scholar]
  26. Purtilo D. T., Gottlieb L. S. Cirrhosis and hepatoma occurring at Boston City Hospital (1917-1968). Cancer. 1973 Aug;32(2):458–462. doi: 10.1002/1097-0142(197308)32:2<458::aid-cncr2820320225>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
  27. REYNOLDS J. T., SOUTHWICK H. W. Portal hypertension. Use of venous grafts when side to side anastomosis is impossible. AMA Arch Surg. 1951 Jun;62(6):789–800. [PubMed] [Google Scholar]
  28. Read R. C., Thompson B. W., Wise W. S., Murphy M. L. Mesocaval H venous homografts. Arch Surg. 1970 Dec;101(6):785–791. doi: 10.1001/archsurg.1970.01340300141024. [DOI] [PubMed] [Google Scholar]
  29. Reynolds T. B. Editorial: Promises. Promises. Hemodynamics and portal-systemic shunt. N Engl J Med. 1974 Jun 27;290(26):1484–1485. doi: 10.1056/NEJM197406272902611. [DOI] [PubMed] [Google Scholar]
  30. Stipa S., Thau A., Cavallaro A., Rossi P. A technique for mesentericocaval shunt. Surg Gynecol Obstet. 1973 Aug;137(2):285–287. [PubMed] [Google Scholar]
  31. Stipa S., Thau A., Ziparo V., Schillaci A. Mesenterico-caval shunt with jugular vein for portal hypertension. Bull Soc Int Chir. 1975;34(3):179–182. [PubMed] [Google Scholar]
  32. Thompson B. W., Read R. C., Casali R. E. Interposition grafting for portal hypertension. Am J Surg. 1975 Dec;130(6):733–738. doi: 10.1016/0002-9610(75)90431-6. [DOI] [PubMed] [Google Scholar]
  33. Thompson B. W., Read R. C. Proceedings: Interposition "H" grafting for protal hypertension. Arch Surg. 1974 Apr;108(4):502–506. doi: 10.1001/archsurg.1974.01350280106017. [DOI] [PubMed] [Google Scholar]
  34. Thompson B. W., Read R. C. Use of the autogenous jugular vein for interposition grafting in portal hypertension. South Med J. 1973 Jul;66(7):818–822. doi: 10.1097/00007611-197307000-00020. [DOI] [PubMed] [Google Scholar]
  35. VALDONI P. L'ipertensione protale; orientamenti e indicazioni curative nell'ipertensione portale. Riforma Med. 1954 Dec 18;68(51):1414–1414. [PubMed] [Google Scholar]
  36. VOORHEES A. B., Jr, BLAKEMORE A. H. Clinical experience with the superior mesenteric vein--inferior vena cava shunt in the treatment of portal hypertension. Surgery. 1962 Jan;51:35–41. [PubMed] [Google Scholar]
  37. Welling R. E., McDermott W. V., Jr Combined caval and portal hypertension with cirrhosis of the liver. A problem in management. Ann Surg. 1973 Feb;177(2):164–166. doi: 10.1097/00000658-197302000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Whipple A. O. The Problem of Portal Hypertension in Relation to the Hepatosplenopathies. Ann Surg. 1945 Oct;122(4):449–475. doi: 10.1097/00000658-194510000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. YEOH K. S., EISEMAN B. Portal vein thrombosis: thrombectomy and porta-caval anastomosis with the use of a graft. Singapore Med J. 1962 Jun;3:64–67. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES