Partial Shunts

Realizing the importance of preservation of hepatic portal flow in order to reduce the incidence of encephalopathy, and liver failure, the concept of partial shunting was actively investigated. Partial shunts are nonselective, decompressing the portal hypertension just enough to reduce variceal hemorrhage but maintaining adequate prograde portal blood flow. Initial attempts at creating a small side-to-side portacaval anastomosis (less than 12 mm) were unsuccessful as these dilated with time, with loss of hepatopetal flow (8). It was not until Sarfeh et al. reported their results with the use of small-diameter (8-10 mm) polytetrafluoroethylene (PTFE) portacaval H-grafts that true partial shunting became established (9,10). A relationship between shunt diameter, direction of portal flow, and incidence of encephalopathy was confirmed (11). Other authors have successfully adapted the use of small-diameter PTFE grafts at the mesocaval level in order to avoid dissection of the hepatic hilum and potentially compromising future liver transplantation (12).

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