Long-term follow-up of distal splenorenal shunts: evaluation by arteriography, shuntography, transhepatic portal venography, and cinefluorography.

Eight patients with patent distal splenorenal shunts were studied after a 22- to 36-month interval. Evolution of hemodynamic and anatomical changes was documented by percutaneous transhepatic portal catheterization, cinefluorography using ethiodized oil droplets, transfemoral splenorenal shuntography, and celiac arteriography. Changes included (a) a decrease in the portosystemic venous pressure gradient, (b) an increase in the size of and flow through both the shunt and the hepatic artery, (c) reversal of portal venous flow, (d) marked dilatation of collaterals and diversion of flow from the superior mesenteric vein to the shunt, and (e) an increase in cardiac output.