Results of Interposition “H” Grafts for Portal Hypertension

Abstract

During the past 9 year, 54 patients underwent interposition graft shunting for variceal bleeding in 48 and intractable ascites in 6, either electively (35 instances) or as an emergency (13 instances). Autogenous jugular was used in 41 instances, homologous vena cava in 9 and Dacron in 5. The interposition graft was placed between superior mesenteric vein and vena cava in 36 instances and the portal vein and vena cava in 19. Using Child''s Clinical Classification, 44 were Class C and 10 Class B. There were 6 (11%) operative deaths with 1 (2.4%) in the elective and 5 (38%) in the emergency group. Encephalopathy was seen in 4 (10%) of those surviving more than 1 year. Two Dacron and 2 homografts thrombosed. Eight of the autografts were patent at autopsy, 18 on angiography and 15 assumed to be patent because patients were asymptomatic. Only 1 of 12 late deaths was related to graft failure. Apparently the operation controls ascites and the autogenous jugular vein is the ideal material. Interposition "H" grafting is a simple, safe procedure that can be used for portal decompression in patients with bleeding varices.