Portacaval shunt with arterialization of the portal vein by means of a low flow arteriovenous fistula.

A new operative technique was designed combining an end-to-side portacaval shunt with arterialization of the intrahepatic portal vein by means of a saphenous vein graft between the right gastroepiploic artery and the stump of the portal vein. The objective of this operation is to perfuse the hepatic portion of the portal vein with a low volume of arterial blood to ameliorate the adverse metabolic consequences of portosystemic decompression. The procedure was performed upon 18 patients with one operative mortality. The mean follow-up period is 15.4 months. The benefits of this operation are evident in the prevention of hepatic decompensation and avoidance of encephalophy, thus permiting unrestricted protein intake. The operation is well tolerated, and the operative mortality appears to be less than that following conventional shunting procedures.