Small-diameter H-graft portacaval shunt reduces portal flow yet maintains effective hepatic blood flow

Small-diameter H-graft portacaval shunts (HGPCSs) effectively treat bleeding varices due to cirrhosis, although the effects of such shunts on hepatic blood flow are not well established. Proponents of HGPCS believe that portal flow diverted through the shunt is regained through increased hepatic arterial inflow while others argue that this flow is never recovered; resulting in compromised nutrient flow. In this study, we sought to determine the effects of HGPCS on effective hepatic and portal blood flow. Patients undergoing HGPCS had portal pressures and flow (via color-flow Doppler ultrasound) measured intraoperatively before and after placement of HGPCS. Effective hepatic blood flow was determined utilizing low-dose galactose clearance 1 day preoperatively and 5 days postoperatively. Over a 7-year period, 64 patients (42 male and 22 female), average age 54 +/- 13.6 years (SD), were studied. Cirrhosis was due to alcohol in 37 patients, hepatitis in 9, alcohol and hepatitis in 5, and assorted other causes in 13. Child's class was A in 11 patients, B in 35, and C in 18. Both portal flow and pressures decreased significantly postoperatively (15 +/- 14.2 to 10 +/- 15.1 mL/min [P < 0.05] and 29 +/- 13.0 to 18 + 6.2 mm/Hg [P < 0.05]), whereas effective hepatic blood flow decreased insignificantly (1441 +/- 1719 to 1332 +/- 863 mL/min). Small-diameter HGPCS significantly reduce portal pressures and portal blood flow while maintaining effective hepatic flow. These findings suggest that hepatic arterialization occurs as early as 5 days after shunting and thus support the application of HGPCS.