Angiographic control of portocaval anastomoses. A study of hepato-portal circulatory changes after shunt (author's transl)

The hepatoportal circulatory changes which occur after porto-systemic shunts have been evaluated in 55 cirrhotic patients studied by post-operative arterioportography. In every one of these cases the shunt was patent. After side to side portocaval shunt (28 patients) the arterioportography shows the complete drainage of the splanchnic blood into the inferior vena cava. A reversed flow was observed in 20 patients. After conventional spleno renal shunt (eight patients) a maintained hepatopetal flow was present only in early angiographic controls, while in later controls all splanchnic blood flow was towards the renal vein, with evidence of reversed portal flow. Even after mesocaval shunt (ten patients) the splanchnic flow was hepatofugal. Instead, after distal splenorenal Warren shunt (two cases) the hepatopetal portal flow seems to be unaffected as evidence by angiography 15 days post-operatively. An increased of the hepatic artery diameter and its intrahepatic branches was observed in 20 out of 27 controls. This hepatic artery "hepertrophy" is related in increased hepatic artery blood flow which seems to be, according to Burchell [5], an important factor in the reestablishment of the liver circulation after portocaval shunt.