DOES THE DIRECTION OF PORTAL BLOOD-FLOW DETERMINE OUTCOME WITH SMALL-DIAMETER PROSTHETIC H-GRAFT PORTACAVAL-SHUNT

Background. Partial portal decompression, as attained by small-diamete r prosthetic H-graft portacaval shunting, continues to gain popularity because of favorable outcomes. This study was undertaken to determine whether the direction of preshunt or postshunt portal blood flow or r eversal in the direction of portal flow occurred with shunting effect outcome after small-diameter prosthetic H-graft portacaval shunt. Meth ods. In 56 consecutive patients the direction of portal flow was deter mined before and after shunting. The direction of portal bloodflow bef ore and after shunting and changes in the direction of portal flow tha t occur with shunting were correlated with 30-day and 1-year survival, as well as with the rate of postshunt encephalopathy. Results. Portal pressures significantly decreased in all with shunting. Whether or no t stratified by Child's classification, neither the preshunt nor posts hunt direction of portal flow affected 30-day or 1-year survival or in cidence of encephalopathy. Eleven patients (significant at p<0.001, Fi sher's exact test) had reversal of portal blood flow with shunting wit hout an increase in 30-day or 1-year survival or incidence of encephal opathy. Conclusions. Small-diameter prosthetic H-graft portacaval shun ts significantly reduce portal pressure and lead to reversal of portal flow in significant numbers. Significant hepatic dysfunction is uncom mon after shunting. Neither the direction of preshunt or postshunt por tal blood flow nor the reversal of portal blood flow with shunting has an effect on clinical outcome after small-diameter prosthetic H-graft portacaval shunt.