Early postoperative angiographic control of the Warren procedure in 40 patients.

Abstract

AbstractBetween December 1975 and December 1980, a total of 43 patients with portal hypertension due to intrahepatic block underwent the Warren procedure for distal splenorenal anastomosis. Forty of them were submitted to celiomesenteric arteriography between the 10th and 90th postoperative days to assess the efficacy of the procedure and to estimate its effects on the portal flow to the liver. On the late venous phase of the celiac angiogram, the patency of the shunt was demonstrated in 37 patients (92.5%), along with a consistent reduction of splenic volume; there was a clear flattening of esophageal varices at esophagoscopy. The shunt was not patent in the other 3 patients (7.5%), all of whom had anatomic venous abnormalities (diameter of the splenic vein smaller than 10 mm and/or abnormal renal vein). Two of these patients rebled soon after the operation, while the third subject underwent a prophylactic renoportal shunt.The effects of the procedure on the mesentericoportal flow were studied on the late phase of the superior mesenteric arteriogram. Venous flow to the liver was unaltered in 28 patients, substantially reduced by a latent partial portal thrombosis in 10 (25%), and totally suppressed in 2. Of these 2 complete portal thromboses, one resulted in early recurrent bleeding, while the other has remained asymptomatic. In spite of the portogastric disconnection, reverse flow in large veins from the portal vein to the cardial varices was observed in 14 patients (35%). Thus, after the Warren procedure, esophageal varices are efficiently decompressed by a patent shunt but portal flow is not always preserved.