Prosthetic H-Graft Portacaval Shunts vs Transjugular Intrahepatic Portasystemic Stent Shunts: 18-Year Follow-Up of a Randomized Trial

Comparisons between Portosystemic Shunting Modalities in Patients with Liver Cirrhosis and Portal Hypertension

“…On the other hand, introduction of radical treatment in many countries made a certain influence on the demand of PSSh producing. 16 Furthermore, Rosemurgy et al 17 found that widespread use of TIPS continues although there is a certain lack of direct evidence of its effectiveness prior to surgical bypass.…”

“…The authors state that patients with Child-Pugh functional class "A" and "B" should have traditional bypass surgery rather than TIPS, leaving TIPS only for patients who present an initially severe (grade "C") condition. 17 Interesting results were obtained in a randomized clinical trial that evaluated the efficacy of emergency TIPS vs. PSSh. The study compared efficiency of TIPS vs. PSSh as a way to stop acute bleeding in emergency situations and was conducted in 154 patients with liver cirrhosis of all Child-Pugh severity groups.…”

“…15,16 Therefore, different variations of traditional decompressive surgery still remain as a method of choice in the leading hepatology centers worldwide. 17 Thus, the development of vascular surgery for PH, both as a stage of preparation for liver transplantation, as well as a part of a possible method for preventing EGV bleeding, remains as an urgent problem to solve in modern hepatology. …”

Emergent nonconventional mesosystemic shunt for diffuse portomesenteric thrombosis: Sparing patients from liver/multivisceral transplantation

“…In the context of diffuse thrombosis in the portal, splenic, and superior mesenteric veins, previously described conventional shunts were not feasible. 1,2,5,6 The outflow of the mesentery had to be restored; otherwise, liver or multivisceral transplantation might have been necessary to prevent further complications secondary to diffuse thrombosis in the portomesenteric system. Our technique of triple surgical mesosystemic shunting, including a mesorenal shunt using the saphenous vein graft and mesocaval shunts using both sides of gonadal veins, was effective and successful in restoring intestinal venous outflow.…”

“…In this setting, surgical shunts have played a major role in the management of patients with portal hypertension and bleeding gastrointestinal varices. [1][2][3] Another option for diffuse mesenteric thrombosis is organ transplantation. However, this is a major undertaking in which the recipient's portomesenteric venous system is completely replaced via multivisceral transplantation.…”