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Interposition "H" Grafting for Portal Hypertension

Bernard W. Thompson, MD; Raymond C. Read, MD
Arch Surg. 1974;108(4):502-506. doi:10.1001/archsurg.1974.01350280106017.
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During the past 4½ years, 24 patients bleeding from varices and three with intractable ascites underwent interposition "H" graft shunting, either electively (21 patients) or as an emergency (7 patients). Autogenous jugular vein was used in 15, homologous vena cava in 9, and Dacron in 4. Portacaval anastomosis was done in 14 and mesocaval in 14. Twenty-five were Child class "C" and two Child class "B." There were four (14.8%) early deaths, with one (4.8%) in the elective and three (43%) in the emergency group. Nine grafts were open at autopsy, eight at splenoportography, and seven assumed patent because patients were asymptomatic. Two Dacron grafts and two homografts thrombosed. There were eight late deaths, only one related to failure of the graft. Apparently, the operation controls ascites, with autogenous jugular vein being the ideal material. Interposition "H" grafting is a simple, safe procedure that can be used for portal decompression in patients with bleeding varices.


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