High patency of proximal splenorenal shunt: A myth or reality ? – A prospective cohort study

Mishra, Pramod Kumar; Patil, Nilesh; Saluja, Sundeep Singh; Narang, Poonam; Solanki, Nisha; Varshney, Vaibhav Kumar

doi:10.1016/j.ijsu.2015.12.071

Cited by 18 publications

(15 citation statements)

References 21 publications

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“…The overall patency of PSRS is reported between 60-90% and the majority of shunt thrombosis occurs after a few months 5 , 6 . After a thorough search of the literature, we could find only one case of in-hospital, radiologically documented shunt thrombosis presenting as re-bleed within 48 hours which was managed conservatively 7 .…”

Section: Discussionmentioning

confidence: 99%

Rescue Devascularization in Coronavirus Disease 19 (COVID-19) Induced Early Shunt Thrombosis After Emergency Proximal Spleno-renal Shunt for Extrahepatic Portal Vein Obstruction

Nayak

Pattnaik

Mohakud

et al. 2022

Journal of Clinical and Experimental Hepatology

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Section: Discussionmentioning

confidence: 99%

Rescue Devascularization in Coronavirus Disease 19 (COVID-19) Induced Early Shunt Thrombosis After Emergency Proximal Spleno-renal Shunt for Extrahepatic Portal Vein Obstruction

Nayak

Pattnaik

Mohakud

et al. 2022

Journal of Clinical and Experimental Hepatology

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“…Одним из основных факторов, ограничивающих применение метода у пациентов с ПГ, зачастую является недостаточный диаметр сосуда, не позволяющий обеспечить адекватный отток из воротной системы и сформировать анастомоз, который также должен иметь достаточный диаметр (минимум 8 мм) [1,2,27,28,34,35]. К сожалению, лишь у небольшого числа пациентов с ПГ левая желудочная вена расширяется до приемлемых для хирургического шунтирования размеров [32][33].…”

Section: а бunclassified

“…Диаметр самого анастомоза составил в среднем 11,03 и 10,63 см соответственно (р = 0,265). Следует отметить, что отсутствие влияния размера шунта на его функцию обусловлено тем, что у всех 50 пациентов изначально был сформирован анастомоз адекватного диаметра (от 8 до 14 мм) [35].…”

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”Left gastric vein to inferior vena cava” bypass in patients with portal hypertension

et al. 2020

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Aim. To present the first Russian experience in the management of portal hypertension of various etiology by creating a selective portosystemic shunt between left gastric vein and inferior vena cava (leftgastric vein caval bypass).Material and methods. “Left gastric vein to inferior vena cava” bypass was performed in 6 patients with portal hypertension: 4 men and 2 women (mean age 40.4 years). The follow-up period ranged from 10 to 36 months.Results. “Left gastric vein to inferior vena cava” bypass was effective in the management of portal hypertension and its complications in 5 out of 6 patients. Complete eradication of esophagogastric varices and no variceal bleeding were observed in long-term period. These patients demonstrated no clinical or laboratory signs of hepatic encephalopathy and/or hepatic failure within the follow-up. One patient with thrombophilia and extrahepatic portal vein obstruction (factor V Leiden mutation) had thrombosis of the shunt and recurrent variceal bleeding in 6 months after surgery because of unauthorized abandonment of the anticoagulation.Conclusion. “Left gastric vein to inferior vena cava” bypass is an effective procedure for prevention of variceal bleeding (or recurrence) in patients with portal hypertension. The limitation of this technique is insufficient diameter of left gastric vein in many patients. This procedure has certain pathophysiological advantages over other types of portosystemic anastomoses due to highly selective nature of the shunt. Thus, this approach should be introduced into surgical treatment of these patients.

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“…The beneficial effects of shunt surgery are mitigated when shunt get blocked. Mishra et al10 reported that 25% (3/12) of NCPF patients developed the shunt blockage during follow up. In present study shunt blockage rate was 1/16 (6.25%), the low rate may be due to the fact that we did not used CT portography routinely in all patients on follow up to assess shunt patency.Splenectomy alone is considered as sub-optimal treatment in NCPF, post splenectomy increase risk of thrombosis of spleno-portal venous axis is there and it can result in increased risk of PHTN related bleed.…”

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confidence: 99%

Splenectomy with endotherapy in non-cirrhotic portal fibrosis related portal hypertension: Can it be an alternative to proximal spleno-renal shunt?

Saluja

Kumar

Govind

et al. 2020

Ann Hepatobiliary Pancreat Surg

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Backgrounds/Aims: Proximal splenorenal shunt (PSRS) is usually done in symptomatic non-cirrhotic portal fibrosis (NCPF). The outcomes of splenectomy with endotherapy in non-bleeder NCPF patients has not been well studied. We here by aimed to study the post-surgical outcomes on short and long-term basis between PSRS and splenectomy among non-bleeder NCPF patients. Methods: The consecutive non-bleeder NCPF patients whom underwent either splenectomy or PSRS from 2008 to 2016 were enrolled. The patients were followed up post-surgery clinically and biochemical investigations, Doppler ultrasound and upper gastrointestinal endoscopy were done as required. The peri-operative parameters compared were operative time, blood loss, hospital stay and morbidity. The long-term outcome measures compared were incidence of portal hypertension (PHTN) related bleed, change in grade of varices, shunt patency, shunt complications and thrombosis of spleno-portal axis. Results: Among 40 patients with non-bleeder status, 24 underwent splenectomy and 16 underwent PSRS. The baseline characteristics including indication of surgery, biochemical investigations and grade of varices were comparable between PSRS and splenectomy. The peri-operative morbidity was not significantly different between two groups. The median follow up duration was 42 months (12-72 months), the decrement in grade of varices was significantly higher in PSRS group (p=0.03), symptomatic PHTN related UGIB was non-significant between PSRS and splenectomy (p=0.5). In PSRS group, 3 (18.3%) patients had shunt thrombosis (n=1) & encephalopathy (n=2) while in splenectomy group two patients developed thrombosis of splenoportal axis. Conclusions: Splenectomy with endotherapy is alternative to PSRS in non-bleeder NCPF patients with indications for surgery.

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High patency of proximal splenorenal shunt: A myth or reality ? – A prospective cohort study

Abstract: Dynamic CT portography is useful for evaluation of shunt patency. Proximal splenorenal shunts have a high blockage rate which has hitherto not been reported.

Cited by 18 publications

References 21 publications

Rescue Devascularization in Coronavirus Disease 19 (COVID-19) Induced Early Shunt Thrombosis After Emergency Proximal Spleno-renal Shunt for Extrahepatic Portal Vein Obstruction

Rescue Devascularization in Coronavirus Disease 19 (COVID-19) Induced Early Shunt Thrombosis After Emergency Proximal Spleno-renal Shunt for Extrahepatic Portal Vein Obstruction

”Left gastric vein to inferior vena cava” bypass in patients with portal hypertension

Splenectomy with endotherapy in non-cirrhotic portal fibrosis related portal hypertension: Can it be an alternative to proximal spleno-renal shunt?

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