Open Access”Left gastric vein to inferior vena cava” bypass in patients with portal hypertension
Author(s) -
В. М. Лебезев,
Gregor Manukian,
Е. Е. Фандеев,
Е.А. Киценко,
Р. А. Мусин,
Е. А. Косакевич,
С. А. Ризаева,
Я. С. Бобылева
Publication year - 2020
Publication title -
annaly hirurgičeskoj gepatologii
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.138
H-Index - 1
eISSN - 2408-9524
pISSN - 1995-5464
DOI - 10.16931/1995-5464.2020127-37
Subject(s) - medicine , portal hypertension , inferior vena cava , surgery , portal venous pressure , anastomosis , thrombosis , portosystemic shunt , splenic vein , gastric varices , radiology , cardiology , cirrhosis
Aim. To present the first Russian experience in the management of portal hypertension of various etiology by creating a selective portosystemic shunt between left gastric vein and inferior vena cava (leftgastric vein caval bypass). Material and methods. “Left gastric vein to inferior vena cava” bypass was performed in 6 patients with portal hypertension: 4 men and 2 women (mean age 40.4 years). The follow-up period ranged from 10 to 36 months. Results. “Left gastric vein to inferior vena cava” bypass was effective in the management of portal hypertension and its complications in 5 out of 6 patients. Complete eradication of esophagogastric varices and no variceal bleeding were observed in long-term period. These patients demonstrated no clinical or laboratory signs of hepatic encephalopathy and/or hepatic failure within the follow-up. One patient with thrombophilia and extrahepatic portal vein obstruction (factor V Leiden mutation) had thrombosis of the shunt and recurrent variceal bleeding in 6 months after surgery because of unauthorized abandonment of the anticoagulation. Conclusion. “Left gastric vein to inferior vena cava” bypass is an effective procedure for prevention of variceal bleeding (or recurrence) in patients with portal hypertension. The limitation of this technique is insufficient diameter of left gastric vein in many patients. This procedure has certain pathophysiological advantages over other types of portosystemic anastomoses due to highly selective nature of the shunt. Thus, this approach should be introduced into surgical treatment of these patients.