Mesocaval "H" graft using antogenous vein graft.

A group of 22 patients with bleeding esophageal varices were treated by creating mesocaval "H" shunts using autogenous veins as the "H" graft. The right external iliac vein was selected as the graft because of its appropriate size in diameter and length, its strength and elasticity. Details in operative technique are outlined. The age of our patients ranged from 24 to 75 years (average age 49), 19 patients had preoperative endoscopy, 10 patients received intraarterial pitressin drip to control hemorrhage, and surgery was done within 10 days of admission in 18 patients. There were two postoperative deaths (both patients Childs Class C), and very few postoperative problems. Right leg edema was a temporary and minimal problem. Encephalopathy was a major problem in only three patients, all of whom had poor hepatic reserve preoperatively. There has been no recurrent variceal bleeding in any of these patients. Our previous experimental data in dogs indicated that the long term patency of these shunts could be assured.