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Small-diameter prosthetic H-graft portacaval shunts in the treatment of portal hypertension

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Chinese Medical Journal 2004年第2期17卷 195-198页

作者：胡何节许戈良李建生杨树高柴仲培徐荣楠 Department of General Surgery Anhui Provincial Hospital Hefei 230001 China

Background Portasystemic shunts, especially total shunts, are effective tools for reducing portal pressure and controlling variceal bleeding but lead to high risk of encephalopathy and accelerating liver failure. The purpose of this study is to evaluate the clinical effects of small-diameter expanded polytetrafluoroethylene (ePTFE ) H-graft portacaval shunts in the treatment of portal hypertension.Methods Thirty-one patients with portal hypertension were treated with ePTFE small-diameter H-graft portacaval shunts from December 1995 to April 2002. Twenty-one had externally ringed grafts and 10 had non-ringed grafts; 20 had 10 mm diameter grafts and 11 had 8 mm grafts. The left gastric artery and coronary vein were ligated in 22 patients. Additionally, 6 patients underwent pericardial devascularization, and splenectomies were performed on 30 patients.Results An average decrease of free portal pressure (FPP) from (32. 13 ±4. 86) cmH2O before shunting to (12. 55 ±5. 57) cmH2O after shunting was observed. Portal blood flow was reduced by 1/3 compared with the levels measured before shunting. Twenty-eight patients survived after the operation, and no upper gastrointestinal rebleeding occurred in the follow-up period (40. 2 months on average). We lost contact with one patient. Color Doppler ultrasonography and/or portography revealed the shunts to be patent in 28 cases and occluded in 2 (6. 4%) cases. Encephalopathy developed in 4 patients (12. 9%).Conclusion Small-diameter ePTFE H-graft portacaval shunts can effectively reduce portal pressure. Moreover, the majority of the hepatopetal flow from the portal vein can be adequately maintained. The reinforced shunts may achieve a higher rate of patency. Morbidity from encephalopathy was less frequent than in pateints receiving total shunts. Small-diameter H-graft portacaval shunts are also effective in preventing recurrent variceal bleeding.

关键词： hypertension portal portacaval shunt surgical blood vessel prosthesis

Partial portacaval shunt with H-grafts to treat portal hypertension

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Frontiers of Medicine 2007年第3期1卷 279-281页

作者： XU Geliang HU Hejie LI Jiansheng YANG Shugao CHAI Zhongpei XU Rongnan Department of General Surgery Anhui Provincial HospitalHefei 230001China

Partial portosystemic shunts have been popularized because of a reported low rate of mortality and morbidity(especially encephalopathy,liver failure and occlusion).The results of partial portacaval shunts[small-diameter expanded polytetrafluoroethylene(ePTFE)H-graft portacaval shunt]were retrospectively reviewed to evaluate the clinical efficacy in the treatment of portal ***-three patients with portal hypertension were treated by small-diameter H-graft of ePTFE portacaval shunt from May 1995 to April ***-three had externally ringed grafts and ten had non-ringed *** had grafts of 10 mm in diameter and 33 had grafts of 8 *** left gastric artery and coronary vein were ligated in all the *** had pericardial devascularization and splenectomy was performed in *** average decrease of free portal pressure(FPP)from(33.24 P4.78)cmH2O before shunting and(13.65P5.65)cmH2O after shunting was *** portal blood flow was reduced by one-third of that before ***-eight patients survived and no upper gastro-intestinal rebleeding occurred in the follow-up period(50.5 months in average).Two were out of *** Doppler ultrasonography and/or portography revealed the shunts were patent in 38 cases and were occluded in three cases(3/41,7.3%).Encephalopathy developed in five cases(5/41,12.2%).Partial(small-diameter ePTFE H-graft)portacaval shunting can reduce the portal pressure *** of the hepatic flow from the portal vein can be maintained *** shunts with reinforced grafts can keep a higher rate of *** morbidity of encephalopathy was lower than those with total *** partial portacaval shunt is effective in preventing recurrent variceal bleeding.

关键词： hypertension,portal portacaval shunt,surgical blood vessel prosthesis

Combined splenocaval or mesocaval C shunt and portoazygous devascularization in the treatment of portal hypertension: analysis of 150 cases

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Hepatobiliary & Pancreatic Diseases International 2006年第1期5卷 70-73页

作者： Liu-Shun Feng and Xiao-Ping Chen Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China Hepatic Surgery Center Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430030 China. Fengliushun@***

BACKGROUND: Portal hypertension is a common disease and its major surgical therapeutic approaches include devascularization and shunting. This study was undertaken to investigate the effects of combined splenocaval or mesocaval C shunt and portoazygous devascularization (combined procedures) on portal hypertension. METHODS: The clinical data of 150 patients with portal hypertension who had undergone combined procedures at the First Affiliated Hospital of Zhengzhou University from May1990 to May 2003 were analyzed retrospectively. RESULTS: The mean free portal pressure (FPP) was 25.6±1.83 mmHg, 18.0±2.07 mmHg and 18.4±2.19 mmHg before operation, after splenectomy plus splenocaval or mesocaval C shunt, and combined procedures, respectively. There was no operative death in all patients. The 1-7 year follow-up of 100 patients showed rebleeding in 3 patients, encephalopathy in 4, thrombosis of artificial vascular graft in 3, and dying from liver failure in 2. CONCLUSIONS: The combined procedures can not only decrease portal pressure but also preserve hepatic blood flow to some extent. It may be one of the best choices for treating portal hypertension in China.

关键词： hypertension portal vein blood vessel prosthesis devascularization shunting

Management of severe Budd-Chiari syndrome:report of 147 cases

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Hepatobiliary & Pancreatic Diseases International 2004年第4期3卷 522-525页

作者： Liu-Shun Feng, Qi-Ping Peng , Ke Li, Xiu-Xian Ma, Yong-Fu Zhao, Xue-Xiang Ye, Pei-Qin Xu and Xiao-Ping Chen Zhengzhou, China Department of General Surgery, First Affiliated Hospi- tal , Zhengzhou University, Zhengzhou 450052 , China and Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China Department of General Surgery First Affiliated Hospital Zhengzhou University Zhengzhou 450052 China.

BACKGROUND:Budd-Chiari syndrome (BCS) is an un- common disorder caused by the obstruction of hepatic ve- nous outflow and/or the inferior vena cava. Major thera- peutic approaches include operation and radiological inter- vention. This study was conducted to investigate the treat- ment of severe BCS. METHODS: The clinical data of 147 patients with severe BCS who had been treated at our hospital from November 1994 to December 2003 were retrospectively analyzed. RESULTS: One hundred twenty-one patients with BCS un- derwent surgery, including mesocaval C type shunt with ar- tificial graft (82 patients), splenojugular shunt (37), meso- jugular shunt (2), percutaneous transhepatic recanalization and dilatation and/or stent placement of the main hepatic vein (MHV) (12), and combined percutaneous transhepa- tic angioplasty (PTA) and stent placement of the inferior vena cava and mesocaval shunt (14). Follow-up for 6-108 months showed excellent results in 102 patients (69.4%), good results in 40 (27.2% ), and 5 deaths. CONCLUSION: Good results could be obtained in most of patients with BCS after different surgical treatments accord- ing to the pathological changes of the IVC and MHV.

关键词： Budd-Chiari syndrome interventional radiology angioplasty blood vessel prosthesis

Role of precoating in artificial vessel endothelialization

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Chinese Journal of Traumatology 2004年第5期7卷 312-316页

作者：肖乐时德 Vascular Surgery Department First Affiliated Hospital of Chongqing University of Medical Sciences Chongqing 400016 China

As the progress of vascular surgery, artificial vessels have become the substitute for large and middle diameter vessels but have not for small diameter ones owing to thrombogenesis and occlusion within a short period of time after being applied. Artificial vessel endothelialization is one of the ideal methods to resolve such issue and has been improved continuously since Herring in 1978 put forward this term in the first time and utilized vascular endothelial cells (ECs) harvested from living animals to perform the test of artificial vessel endothelialization. However, human endothelial cells show little adhesion to the currently available vascular graft materials and some expanded polytetrafluoroethylene (ePTFE) grafts have shown only 10%+/-7% endothelial cell attachment rate (ECA, ie, attachment of ECs when incubated in vitro). Moreover, when the graft is exposed to pulsatile blood flow, a high proportion of cells are washed off from the lumen. Maximum cell loss occurs in the first 30-45 min after exposure to pulsatile flow, with up to 70% of cells lost. After that, a slower exponential loss occurs over the next 24 h. The lack of retention of cells could be partly overcome by sodding, but other techniques, involving engineering the lumen to improve ECA and endothelial cell retention rate (ECR, ie, retention of ECs when the grafts are exposed to pulsatile flow) have been developed. These include shear stress preconditioning, electrostatic charging and, above all, most successfully to date, precoating with EC specific adhesive glues that are mostly found in the extracellular basement membrane of blood vessels. The commonest are chemical coatings, preclotting, chemical bonding, and surface modifications.

关键词： blood vessel prosthesis Coated Materials, Biocompatible blood vessel prosthesis Implantation Cell Adhesion Collagen Comparative Study Female Fibronectins Humans Laminin Male Materials Testing Prognosis prosthesis Design Pulsatile Flow Risk Assessment Stress, Mechanical Treatment Outcome