Portal-Systemic Shunts in the Treatment of Portal Hypertension

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PORTAL-SYSTEMIC shunts are now recognized by most physicians as the most effective means of relieving portal hypertension complicated by bleeding esophageal varices or by medically resistant ascites. The term ‘portal-systemic shunt’ includes all types of surgical venovenous anastomoses that divert portal venous blood into the systemic circulation; it thus includes portacaval, splenorenal, and mesenteric-caval shunts.

The two major deterrents to the surgical relief of portal hypertension by shunt procedures are the mortality rate of the operation and early postoperative period, and the morbidity that may occur in survivors. In an effort to identify the major factors that contribute to mortality and to morbidity, an analysis was made of the clinical course of patients with portal hypertension who underwent portal-systemic shunt procedures at the Cleveland Clinic Hospital in the period from 1947 through 1964. This report presents the results of the analysis.

Clinical Material

During the 17 years from 1947 through 1964, 76 portal-systemic shunt procedures were performed on 74 patients at the Cleveland Clinic Hospital. There were 44 males and 30 females, a ratio of 1.5 to 1. The ages ranged from 6 months to 73 years; the largest group of patients were in the fourth decade.

Four types of portal-systemic shunts were employed in this series of patients: (l) end-to-side portacaval, (2) side-to-side portacaval, (3) splenorenal, and (4) superior mesenteric vein to inferior vena cava (Fig. 1). We have believed and continue to believe that the portacaval shunt is superior to other types of shunts in decreasing portal hypertension; . . .



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