To the Editor.—Belghiti et al (Archives 1981;116:1121-1124) concluded from their angiographie studies that the effects of the distal splenorenal shunt (DSRS) do not differ hemodynamically from those of a side-to-side portacaval shunt after three months. From their data, this conclusion is unjustified and erroneous.
Hemodynamically, a side-to-side portacaval shunt has two effects on portal hypertension: (1) it converts the portal vein to an outflow track with hepatofugal flow, and (2) it reduces pressure in the portal venous bed. The data presented in their report showed that 12 of the 15 patients studied three to 36 months after installation of a DSRS continued to have prograde portovenous flow,
Venous-phase study of selective superior mesenteric artery injection. Upper left, Before installation of distal splenorenal shunt (DSRS). Upper right, Immediately after installation of DSRS Lower left, At follow-up four years later. Lower right, At follow-up nine years after installation. Note continued good