[Arterialisation of the Portal-vein in Conjunction With a Therapeutic Portacaval-shunt - Long-term Results of a Prospective Randomized Controlled-study]

To evaluate the benefit of arterialisation of the portal vein in conjunction with a therapeutic end-to-side portocaval shunt, a prospective randomised study, was started in december 1979 comparing these two techniques in Child A and B cirrhotic patients with a hepatopedal portal flow of at least 100 ml per min. Sixty-four patients were included in the study: 33 were submitted to portocaval shunt (NART) and 31 were arterialised (ART). The two groups of patients were similar for clinical and haemodynamic parameters. Arterialisation lowered the operative mortality for the whole group (ART: 6.5 %, NART: 12 %) and in high risk patients; Child class B patients (ART: 0 %, NART: 22 %) and emergency operation (ART: 0 %, NART: 17 %) but the difference is not statistically significant. Postoperative ascites was more frequent in arterialised patients (ART: 45 %, NART: 18 %; p = 0.02), with an increased need for reoperation (ART: 26 %, NART: 6 %; p < 0,05). The mean follow-up time was 56,9 +/- 28,1 months (SD) for the 58 surviving patients. The five-year actuarial survival rate was 68 % for ART patients and 60,6 % for NART patients (NS). In Child B patients the five-year actuarial survival rate was 75 % in ART patients and 22 % in NART patients (p < 0,05). Actuarial estimation of arterialisation patency - proved by angioscan - was 38 % at five years. There was no significant difference in postoperative and long-term encephalopathy and liver function. In conclusion, arterialisation of the portal vein in conjunction with a therapeutic end-to side portocaval shunt improved survival in high risk patients (Child class B), without increasing operative mortality, with a higher incidence of postoperative ascites and without a decrease in the incidence of long-term encephalopathy.