Complications and Patency Rate of Portosystemic Shunts in Chronic Liver Diseases

Document Type : Research Paper




ntroduction:Cirrhosis is the most important etiology of portal hypertension worldwide. Even with improvements in noninvasive therapies, portosystemic shunts still remain one of the most important approaches after failure in medical treatment. Transjugular Intrahepatic Portosystemic shunt and liver transplantation are alternatively used in other countries. Evaluation of complications and patency rates can be a great help in choosing the best technique in patients. The aim of this study was to evaluate patency rate and complications of portosystemic shunts in patients with chronic hepatic diseases.
Materiasl and Methods: In this cross sectional study, from summer 2000 to spring 2004, carried out at General and Vascular Surgery Departments 19 patients with portal hypertension underwent surgery. Patients with portosystemic shunts were followed up for at least one year after surgery, considering blood flow in anastomosis, using color Doppler ultrasonography and symptoms such as gastro intestinal bleeding, hepatic encephalopathy and etc. Data were analyzed using SPSS version 13 and descriptive statistics.
Results:Male to female ratio was 1:1.7. Portosystemic shunt was performed for 16 patients (2 distal splenorenal, 10 central splenorenal, 2 portocaval, 2 mesocaval) and 3 underwent splenectomy. Of patients 2 complicated with pneumonia after a week, and 2 with encephalopathy. After at least one year, 66.6% of shunts were patent, 8% were closed and in 25.4% doppler ultra sonography could not localize the shunt. One patient died under surgery. There was no death at the end of the first year; but during a 6 years follow up, 6 mortalities occurred.
Conclusion: The major etiology of portal hypertension in these patients was cirrhosis secondary to hepatitis B. This finding is due to the cultural and religious differences with other countries. There was no relationship between pneumonia and splenectomy (p= 0.45). Also, no significant difference observed between pre and post surgery encephalopathy (p =0.14). Mortality rate did not depend on pre (p= 0.09) and post (p= 0.11) surgery encephalopathy. Survival rate of patients was 94.7% after one year and 73.7% after 2 years, demonstrating better results in comparison with other similar studies.


1- Braunwald E, Hauser S, Fauci A, longo D, Kaster D, Gameonb G. Harrison principle of medicine. 16th ed.
Newyork: MC Graw-Hill; 2005.
2- Johanston KH. The management of portal hypertension. In: Rutherford RR, editor. Vascular surgery. 6th ed. USA:
Saunders; 2005. 1321.
3- Pagliaro LA. Portal hypertension and treatment. J Hepatol 1995; 23 (2):36
4- Andrew SW, Layton FR. Current management of portal hypertension. J Gastrointest Surg 2005; 9(7):992-1005.
5- stipa S , Balducci G, Ziparo V.Total shunting and elective management of variceal bleeding.Word J Surg
6- Harley HA, Morgan T, Redeker AG. Results of a randomized trial of end to side portocaval shunt and distal
splenorenal shunt in alcoholic liver and variceal bleeding. Gastroenterol 1986; 91(4):807-809.
7- Uravic M, Depolo A, Dobrial R, Krouse I, Basic G, Stimac D, et al. Portosystemic shunt: our twenty years
experience. Zentralbl Chir 2002; 127(11):971-974.
8- Poli J, Ggroszmam RJ. Hmodynamic Factor involved in the development and rupture of esophageal varices .
Semun Liver Dis 1986; (2): 318.
9- Turnes J, Garcia-Pagaqn JC, Abraldes JG,Hernandez-Guerra M, Dell’Era A, Bosch J. Pharmacological reduction
of portal pressure and long-term risk of first variceal bleeding in patients with cirrhosis. Am J Gastroenterol 2006;
10- Fernandez JL , Bondia ,santoyo J , Perez C , Mera S et al. Calibrated portocaval H graft shunt in variceal
hemorrhage .Hepatogastro Enterol 2003;50(54):200-4.
11- Rosemary AS, Serafini FM, Zervos EE, Goode SE. small-diameter prosthetic H-graft portocaval shunt:
definitive therapy for variceal bleeding. J Gastrointest Surg 1998; 2(6):459-465.
12- Orozco H, Mercado MA, Granados J, Hernandez J, Tileve M. Selective shunts for portal hypertension: Current
role of a 21-year experience. Liver Transpl Surg 1997; 3(5):475-80.