Portacaval H-graft: relationships of shunt diameter, portal flow patterns and encephalopathy.

Small-diameter protacaval H-grafts, 10, 12, or 14 mm, were constructed in 29 cirrhotic patients with previous or active variceal hemorrhage. When 10 mm grafts were used in combination with portal collateral outflow ligation, varying degrees of prograde portal flow were maintained in 50% of the patients. When shunt size was greater, prograde flow was lost in more than 90%. The incidence of spontaneous postoperative encephalopathy was 11% in patients with prograde flow, compared with 50% in those with retrograde flow (p = 0.05). It is concluded that maintaining prograde portal flow after portacaval shunt is essential in minimizing postoperative encephalopathy. Prograde portal flow may be achieved in 50% of patients using 10 mm PTFE portacaval H-grafts combined with portal collateral ligation.