Treatment of postshunt encephalopathy with secondary arterialization: an experimental study in the rat

Secondary arterialization of the hepatic stump of the portal vein has been performed in rats 7 days after portacaval anastomosis (PCA) at a date when the electrocorticographic changes of postshunt encephalopathy were evident. A complete regression of encephalopathy ensued. This correlated with an increase in the weight of the liver and estimated hepatic blood flow. These results confirm the efficiency of liver arterialization, primary or secondary, in the treatment of postshunt encephalopathy. In the groups of rats studied in this experiment a significant correlation was always found among encephalopathy, liver weight: body weight ratio, and hepatic blood flow. This reinforces the hypothesis that a decrease in hepatic blood flow is the main factor in the generation of liver atrophy, decrease of hepatic function, and encephalopathy following portacaval shunt. Primary arterialization of the liver in humans has not gained much favor because of technical difficulties, a high mortality rate, and the absence of clear-cut evidence of its efficiency. Our results suggest that arterialization of the liver might better be kept as a secondary procedure for those cases in which encephalopathy develops after PCA.