[Control of the patency of porto-systemic anastomoses]

After having discussed the direct and indirect methods to control the patency of porto-systemic anastomoses, the Authors report on their series of 42 cases (28 side-to-side porto-cava shunts, 6 end-to-side porto-cava shunts, 6 spleno-renal shunts, 2 mesenterico-cava shunts) where the postop. control was carried out with portography, hepatic superselective arteriography in 29 cases, transcaval catheterism of the anastomosis in 6 patients, and pre-op., and post-op. echotomography in 15 cases. Portography revealed 39 cases of patent anastomosis and thrombotic occlusion in 3 cases. The typical sign of shunt patency is the visualisation of the inferior V.C. and the less frequent disappearance of right gastric reflux. Furthermore the investigations consented the evaluation of altered post-shunt hepato-portal flow: side-to-side porto-cava shunt (25 patent anastomoses) revealed a complete deviation of portal glow towards the I.V.C. and in 15 cases there was inverted portal flow; portography after splenorenal shunt (5 cases of patent anastomosis) showed a preserved hepatopetal portal flow only in early controls (7 days) while in all long term controls it was hepatofugal. In 13 cases the morphology of the hepatic arterial system was compared before and after surgery; in 12 cases the hepatic artery was larger and its intrahepatic branches more tortuous after surgery Ultrasonography revealed only 8 patent shunts out of 15 examined since the amount of gas in the bowel rendered the exam technically insufficient.