Mesocaval H Venous Homografts

During the last year, seven men bleeding from varices and one with intractable ascites underwent, either electively or as an emergency (three), mesocaval shunting with the use of homologous vena cava (H graft). Autopsy in two patients, who died a few weeks postoperatively from hepatorenal failure, showed that the grafts were open. Splenoportography some months later demonstrated "balanced" shunts in five of the six survivors. The exception underwent a repeat procedure and now has a functioning homograft. A death from hematemesis 11 months after surgery was associated with obliteration of the shunt, possibly from compression between the pancreas and duodenum. Since one of the operative fatalities sustained pancreatic injury, the graft is now brought below the duodenum. H-grafting enhances the many technical advantages of mesocaval shunting by eliminating the need to uproot the inferior vena cava. The question whether venous homografts stay open in man remains.