Role of distal splenorenal shunt for long‐term management of variceal bleeding

Jm, Henderson

doi:10.1007/bf00294402

Cited by 28 publications

(23 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Maintenance of some degree of hepatopetal perfusion and portal pressure gradient is reported to be correlated with low risk of encephalopathy and acceleration of liver failure [5,25,26]. In addition, the type of surgical shunt in patients with cirrhosis or other liver disease should be chosen according to prognosis including likelihood of liver transplantation, anatomy and personal surgical experience.…”

Section: Secondary Prophylaxis Of Rebleedingmentioning

confidence: 99%

Current state of portosystemic shunt surgery

Wolff

Hirner

2003

Langenbeck's Archives of Surgery

View full text Add to dashboard Cite

In cirrhotics, elective operations using portal flow preserving techniques such as a selective distal splenorenal shunt (Warren) and a partial portocaval small diameter interposition shunt (Sarfeh) should be preferred. Rarely, end-to-side portocaval shunt may serve as a salvage procedure if emergency endoscopic treatment or transjugular intrahepatic portosystemic shunt insertion fails to stop bleeding. Until definitive results from randomized trials are available patients with good prognosis (Child-Pugh A and B) should be regarded as candidates for surgical shunts. For patients with noncirrhotic portal hypertension, in particular with extrahepatic portal vein thrombosis, portosystemic shunt surgery represents the only effective therapy which leads to freedom of recurrent bleeding and repeated endoscopies for many years, and improves hypersplenism without deteriorating liver function or encephalopathy. Gastroesophageal devascularization and other direct variceal ablative procedures should be restricted to treat endoscopic therapy failures without shuntable portal tributaries.

show abstract

Section: Secondary Prophylaxis Of Rebleedingmentioning

confidence: 99%

Current state of portosystemic shunt surgery

Wolff

Hirner

2003

Langenbeck's Archives of Surgery

View full text Add to dashboard Cite

show abstract

“…We assumed a patient with a DSRS would undergo an angiogram 1 week after surgery to check for shunt patency. 17 If shunt thrombosis was detected, we assumed that the patient would undergo splenectomy and gastric devascularization during the same hospitalization. 18 Finally, we assumed that the patient would not develop late DSRS dysfunction.…”

Section: Methodsmentioning

confidence: 99%

“…18 Finally, we assumed that the patient would not develop late DSRS dysfunction. 17 For the TIPS arm, we assumed that the patient would be followed with Doppler ultrasound for shunt dysfunction, i.e., occlusion, stenosis, and thrombosis, and that dysfunction would lead to dilation of the stent or placement of a new stent. In our model the probability of an episode of stent dysfunction in the TIPS arm was independent of other episodes of stent dysfunction.…”

Section: Methodsmentioning

confidence: 99%

“…We used the reported probability of TIPS patency, patency after intervention for dysfunction without requiring a new stent, and patency after intervention for dysfunction that required a new stent. 14,17,19 As a conservative estimate, the probability of death when a patient had a TIPS revised for stent dysfunction was similar to a patient undergoing their first TIPS. A patient undergoing a successful revision of the TIPS would require dilation of the stent, removal of thrombus from the existing stent, or placement of a new stent.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Decision–Analysis of Transjugular Intrahepatic Portosystemic Shunt Versus Distal Splenorenal Shunt for Portal Hypertension

et al. 1999

View full text Add to dashboard Cite

Variceal hemorrhage, a potentially life-threatening complication of portal hypertension caused by cirrhosis, results in 15,000 hospital admissions in the United States annually. 1 In the past, the definitive management of portal hypertension has been portal-decompressive surgery. Creating a communication between the hypertensive portal vein or its principal tributaries and the normotensive inferior vena cava or its principal tributaries improves portal pressure and decompresses varices. The distal splenorenal shunt (DSRS) is one such communication that has been studied extensively in Child' s class A cirrhosis. Because of its selective nature, it can decrease portal hypertension while minimizing the risk of portosystemic encephalopathy, an advantage that is not enjoyed by less selective shunts.Transjugular intrahepatic portosystemic shunt (TIPS) is a less invasive, radiologic procedure in which a shunt is created in the hepatic parenchyma between the portal and hepatic veins. TIPS is analogous to a side-to-side surgical portocaval shunt but avoids the risk of surgery. Since the first successes were reported by Colapinto et al., 2 TIPS has become a frequently used alternative to surgery in the management of variceal bleeding that is unresponsive to conventional medical and endoscopic therapy. It also has been used for the secondary prophylaxis of variceal bleeding and for refractory ascites. 3 TIPS is preferred to surgery in patients with reduced life expectancy and in whom shunt surgery is risky, as in Child' s class C cirrhosis. TIPS has also been used in patients with longer life expectancy, such as in Child' s class A cirrhosis patients. However, the use of TIPS in patients with longer life expectancy has been called into question because of high rates of stent dysfunction (occlusion, thrombosis, or stenosis) ranging from 33% to 66% within the first 12 months of placement. [3][4][5][6][7] In patients with long survival, the surgical shunt might be preferable, but this has not been evaluated in a systematic fashion.The aim of our study was to investigate the effectiveness and costs of TIPS compared with DSRS in Child' s class A cirrhosis using a deterministic decision analysis model. We developed the model to examine the main effects of mortality from each procedure and stent dysfunction for TIPS. PATIENTS AND METHODSWe constructed a decision analysis model to compare outcomes over 2 years for a patient with Child' s class A cirrhosis undergoing either a DSRS or TIPS. Events of interest were procedure death, dysfunction of TIPS, dysfunction of DSRS, and death from liver disease in each year of the model. In the model, dysfunction of TIPS was defined as any abnormality detected by Doppler ultrasound that would lead to a revision of the TIPS, whether this was stenosis, occlusion, or thrombosis. 4 We defined DSRS dysfunction as thrombosis detected on scheduled angiography 1 week after DSRS surgery. Because of the lack of comparative data, we chose not to evaluate the outcomes of encephalopathy and bleeding. We pe...

show abstract

“…The standard surgical mesocaval shunt is created by constructing a conduit between the SMV and the IVC (5). By contrast, a splenorenal shunt is simply constructed by creation of an anastomosis between the two veins (17).…”

Section: Percutaneous Extrahepatic Portosystemic Shuntsmentioning

confidence: 99%

Evaluation of MR/Fluoroscopy–guided Portosystemic Shunt Creation in a Swine Model

Arepally

Karmarkar

Qian

et al. 2006

Journal of Vascular and Interventional Radiology

View full text Add to dashboard Cite

RESULTS: Successful MR-guided IVC/SMV punctures were performed in all 20 procedures (100%). All three shunts were deployed. Stent-grafts had the poorest mechanism for securing a shunt. The vascular anastomotic device and the bridging stent had more secure anchoring mechanisms but also had higher technical failure rates (50% and 40%, respectively). When deployed successfully, the vascular anastomotic device resulted in no bleeding at the sites of punctures at necropsy. CONCLUSION: Percutaneous shunts and vascular anastomoses between the portal mesenteric venous system and IVC were successfully created with use of a combination of MR imaging and conventional fluoroscopy for guidance.

show abstract

Role of distal splenorenal shunt for long‐term management of variceal bleeding

Cited by 28 publications

References 36 publications

Current state of portosystemic shunt surgery

Current state of portosystemic shunt surgery

Decision–Analysis of Transjugular Intrahepatic Portosystemic Shunt Versus Distal Splenorenal Shunt for Portal Hypertension

Evaluation of MR/Fluoroscopy–guided Portosystemic Shunt Creation in a Swine Model

Contact Info

Product

Resources

About