The Effects of Retrograde Portal Venous Flow Following Side-to-Side Portacaval Anastomosis: A Comparison With End-to-Side Shunts*

Murray, John F.; Mulder, Donald G.

doi:10.1172/jci104372

Cited by 30 publications

(2 citation statements)

References 7 publications

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“…Murray and Mulder found that normal dogs did not do so well after SS shunt as after ES shunt and that the blood flowing retrograde in the portal vein invariably showed less clearance of oxygen and BSP than of hepatic venous blood (2). Studies at the time of portacaval shunt by our surgical colleagues, Mikkelsen, Turrill, and Pattison, also indicated less extraction of oxygen and BSP from backflowing portal blood than from hepatic venous blood (10).…”

mentioning

confidence: 82%

Assessment of Portal and Hepatic Hemodynamics after Side-to-Side Portacaval Shunt in Patients with Cirrhosis*

Redeker¹,

Kunelis²,

Yamamoto³

et al. 1964

J. Clin. Invest.

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mentioning

confidence: 82%

Assessment of Portal and Hepatic Hemodynamics after Side-to-Side Portacaval Shunt in Patients with Cirrhosis*

Redeker¹,

Kunelis²,

Yamamoto³

et al. 1964

J. Clin. Invest.

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“…Clinical studies comparing the end-to-side with the side-to-side portacaval anastomosis arc lacking. Experimental studies in dogs with a side-to side shunt [11] and in the 3-vascular perfused rat liver [12] demonstrated that the prograde perfusion of the sinusoid has a much higher metabolic capacity than the retrograde pathway. Thus, side-to-side shunts with their proportion of retrograde flow which, in nor mal dogs, accounted for 70% of the hepatic arterial inflow [13] may have a higher risk of HE than shunts maintaining prograde sinu soidal blood flow, e.g.…”

Section: He and Portosystem Ic Sh U N Tsmentioning

confidence: 99%

Transjugular Intrahepatic Portosystemic Shunt and Hepatic Encephalopathy

Rössle

Piotraschke²

1996

Dig Dis

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Hepatic encephalopathy (HE) is a frequent complication of portosystemic shunts with an incidence of about 25%. In side-to-side shunts, such as the transjugular intrahepatic portosystemic shunt (TIPS), there is relation between the incidence of postshunt HE and the diameter of the shunt. A smaller shunt with a diameter of < 8 mm has a lower risk of HE by maintaining some prograde portal perfusion in most patients and preventing arterioportal blood flow which may be of disadvantage in most conditions. On the other hand, a smaller shunt diameter limits the reduction in the portal-systemic pressure gradient and, therefore, may have a higher risk of rebleeding. The size of the shunt must be based on these risks which may be estimated by factors such as age, Child class, previous episodes of HE, size of varices and severity of previous bleedings. In retrospect, the decision for a specific diameter, i.e. pressure reduction, was right if the patient’s liver function remained stable after TIPS, no HE occurred, and the varices disappeared. If this is not the case, the shunt diameter needs fine tuning with reduction in case of HE or functional deterioration, or enlargement if rebleeding occurred or the varices show a higher risk of such an event. This potential of fine tuning at any time is the major advantage of TIPS over the surgical shunting procedures.

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Massive Hepatic Necrosis Following Portacaval Shunt

Koenemann¹

1966

JAMA

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The Effects of Retrograde Portal Venous Flow Following Side-to-Side Portacaval Anastomosis: A Comparison With End-to-Side Shunts*

Cited by 30 publications

References 7 publications

Assessment of Portal and Hepatic Hemodynamics after Side-to-Side Portacaval Shunt in Patients with Cirrhosis*

Assessment of Portal and Hepatic Hemodynamics after Side-to-Side Portacaval Shunt in Patients with Cirrhosis*

Transjugular Intrahepatic Portosystemic Shunt and Hepatic Encephalopathy

Massive Hepatic Necrosis Following Portacaval Shunt

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