XXXX in cirrhotics. A retrospective analysis.

@entity1 @entity101 @entity548 @entity715 @entity204
The development of @entity715 in the portal bed of cirrhotic @entity1 presents special problems in diagnosis and treatment. In the cirrhotic population treated for portal @entity101 at our Surgical Department during the period 1967-1983 (512 @entity1 ), the incidence of @entity715 in the portal bed was 16.6% (85 @entity1 ). Bleeding was the main presenting symptom (70/85), with a mean of four episodes prior to treatment. Careful angiographic studies and intraoperative evaluation are fundamental steps to determine the exact anatomical involvement, the presence of recanalized veins or fresh occluding clots, and the applicability of shunt procedures. A massive portosplenomesenteric involvement often associated with poor surgical possibilities was found in 19 @entity1 (22.3%). The presence of partially recanalized veins and fresh occluding clot suitable for disobliterative techniques prior to shunt was found in 16 @entity1 , and out of 73 operated @entity1 a total of 55 shunt procedures could be performed. Fifty-three @entity1 who bled from varices could be followed up to 5 years: 39 underwent a shunt procedure with a 51.2% 5-year survival rate, while only one of 14 nonshunted or nonoperated survived up to 3 years, and a lethal @entity548 was the cause of @entity204 in all but one. Disobliterative techniques (Fogarty thrombectomy and endovenectomy of intimal fibrotic thickenings) prior to shunting provided a good long-term patency rate with a 50% protection from lethal @entity548 recurrences. Nonshunt procedures and the extensive involvement of the portal bed are associated with bad prognosis. Also, endoscopic sclerotherapy, attempted in @entity1 with massive @entity715 , could not prevent recurrences and @entity204 from @entity548 . Despite a 30% failure rate in our study, shunting surgery should be considered the only therapeutical possibility of preventing further @entity715 and consequent life threatening @entity548 episodes.
