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June 1957, Vol 74, No. 6 >
ARTICLE | June 1957

End-to-Side Portacaval Shunt

JOHN L. MADDEN, M.D.
AMA Arch Surg. 1957;74(6):978-988. doi:10.1001/archsurg.1957.01280120156019.
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End-to-Side Portacaval Shunt 

Arthur B. Blakemore, M.D., and Arthur B. Voorhees Jr., M.D., New York  The key to a successful portacaval shunt is a rapidly moving stream of blood. The precise mechanism by which the process of thrombosis is accelerated in a slow-moving stream or retarded in a fast-moving stream is not known, but for practical purposes this observation may be accepted for fact. A high rate of flow can be achieved where the pressure within the portal system is high and the pressure within the vena cava or renal vein is low, thereby establishing a satisfactory pressure gradient. A high rate of flow can be further assured by minimizing peripheral resistance, particularly in the portal or the splenic vein. Angulation and constriction of the vein along its course or at the site of anastomosis, or turbulence in the vena cava or renal vein in close proximity to the

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