Effective Spontaneous Portacaval Venous Shunt

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INCREASED resistance to blood flow in the liver or portal venous system results in portal venous hypertension and the development of collateral pathways bypassing the liver and shunting the blood into the systemic circulation. Reversal of direction of flow through the coronary and short gastric veins shunts blood by way of the esophageal and paraesophageal veins into the azygos and hemiazygos system and the superior vena cava. Esophageal and gastric varices so formed may be the source of fatal hemorrhage. Other channels of venous outflow include reversed flow in the inferior and superior mesenteric vessels with ultimate passage to the inferior vena cava.

In addition, new channels may appear through enlargement or recanalization of small veins, or the growth of new vessels in fibrous adhesions. These new channels may be numerous, and sometimes are of a caliber that approaches the surgically produced portasystemic venous shunts. However, they usually are of small caliber, tortuous, and almost never effective in reducing the portal blood pressure to normal levels. Rarely, spontaneous shunts of large diameter have developed between the splenic and left renal veins,1, 2 yet have not brought the portal pressure within the normal range.

Our report concerns two cases in which a large venous channel developed and emptied into the inferior vena cava, mimicking a surgically produced end-to-side portacaval shunt, and in one case serving as a hemodynamically effective run-off channel preventing significant elevation of portal venous pressure.

Report of Cases

Case 1. A 56-year-old woman was first admitted to the. . .



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