Abstract
Conventional tests to determine the patency of portacaval anastomoses (PCA) are indirect, inferential, and inaccurate. Superior mesenteric arteriography and percaval catheterization of the portal vein are two direct methods of evaluating shunt patency. Thirty-four patients who had had PCA constructed 6 months to 12 years previously had superior mesenteric arteriograms and portacavanastomosograms (shuntograms) which were compared with the results of esophagoscopy, esophagography, and ammonia tolerance tests (ATT). The two angiographic technics each established the correct diagnosis in 97% compared with 83% for esophagoscopy, 81% for barium contrast esophagography, and 71% for ATT's. The presence of aneurysms of the inferior vena cava was associated with patent shunts in 91% of the patients. Aneurysms were absent in patients with occluded or narrowed anastomoses.
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