Objective: To assess the results of left gastric vein to inferior vena cava (IVC) shunts with externally supported (ringed) polytetrafluoroethylene (PTFE) grafts in six patients with considerably dilated left gastric veins who required portal decompression.
Design: Open study.
Setting: University hospital, Japan.
Subjects: Six patients with advanced portal hypertension and massive oesophageal bleeding.
Interventions: The PTFE graft was first anastomosed end to side to the IVC, and then end to end (n = 4) or end to side (n = 2) to the left gastric vein.
Main outcome measures: Short term and long term morbidity and mortality.
Results: There were no operative mortality or morbidity. Endoscopic examination postoperatively showed gradual, steady improvement in the oesophageal varices, and the hyperaemic appearance of the mucosa had disappeared within 10 months in all cases. Median follow up was 19 months (range 10-70); one patients rebled after occlusion of the graft at 12 months, one died of hepatocellular carcinoma at 16 months, and the remaining four patients are well with patent grafts at 10, 22, 40, and 70 months, respectively.
Conclusions: These results confirm the effectiveness of externally supported PTFE grafts in left gastric vein to IVC shunts, and remove the technical restraints that have prevented surgeons from recommending the operation in the past.