In spite of ideal present day management, 25% of patients who bleed from esophageal varices continue to succumb to hemorrhage. Those who fail to respond to conservative measures require surgical intervention. Major surgery on a patient already taxed by exsanguinating hemorrhage and hepatic decompensation is accompanied by a high mortality.
White et al,1 Piccone and LeVeen,2 and Christopherson et al3 have recently described the use of an umbilical systemic vein shunt with low operative mortality to control bleeding from esophageal varices. Their reports indicate that flows obtained under existing portosystemic pressure differentials were sufficient to abate exsanguination.
Gott et al4 have described a non thrombogenic coating technique for surfaces using graphite, heparin sodium, and benzalkonium chloride. Zarins et al5 have recently reported their results with splenofemoral or external jugular shunts to relieve portal hypertension in dogs utilizing the Gott graphite-benzalkonium-heparin coating. We6 have developed