Long-term patency of the mesocaval C shunt

Reports of thrombosis rates as high as 40 percent with the mesocaval H shunt led us to review our results with the mesocaval C shunt in 33 consecutive patients. Their ages ranged from 23 to 69 years (mean 50 ± 12 years). There were 21 male and 12 female patients. The causes of portal hypertension included alcoholic cirrhosis in 13 patients, primary biliary cirrhosis in 6 patients, postnecrotic cirrhosis in 6 patients, cryptogenic cirrhosis in 3 patients, the Budd-Chiari syndrome in 4 patients, and portal vein thrombosis in 1 patient. Twelve patients were in Child's class A, 8 were in Child's class B, and 13 were in Child's class C. Operative mortality was 24 percent (8 of 33 patients) but occurred only in class C patients under nonelective conditions. Shunt patency was determined by one or more of the following: autopsy, angiography, and a lack of recurrent varices or hemorrhage. Autopsies were performed in 12 patients from 1 week to 72 months after operation. All 12 C shunts were widely patent. Angiography was performed in 13 patients from 1 to 38 months postoperatively. All 13 C shunts were patent; however, 2 eventually stenosed and attempts at balloon angioplasty were only moderately successful. Follow-up to time of death or to date was possible in 24 of 25 survivors, and ranged from 3 to 123 months. Evidence of recurrent varices, variceal hemorrhage, or both developed in only two patients (2 of 24, 8 percent), both of whom had stenosed shunts.