Hepatic arterialization and portacaval shunt in hepatic cirrhosis. An assessment.

Abstract

A survey of the results obtained by four teams of workers shows that hepatic arterialization has usually been combined with elective portacaval anastomosis (PCA); in some patients, however, it has been done for the relief of encephalopathy months or years after PCA, and in other patients it has been associated with emergency PCA. Total hepatic blood flow after PCA plus arterialization with a small-caliber artery is equal to, or slightly greater than, the preshunt flow. After PCA plus arterialization the immediate postoperative complications are no worse than after PCA alone, but the subsequent incidence of portosystemic encephalopathy is less. The arteriovenous anastomosis itself is unlikely to be permanent. If it remains patent throughout the first postoperative year, which is the most critical phase of the postshunt course, it will have served a useful purpose.