RESUMO
Cirrhosis is the most important etiology of portal hypertension worldwide. Even with improvements in noninvasive therapies, portosystemic shunts still remain one of the most important approaches after failure in medical treatment. Transjugular Intrahepatic Portosystemic shunt and liver transplantation are alternatively used in other countries. Evaluation of complications and patency rates can be a great help in choosing the best technique in patients. The aim of this study was to evaluate patency rate and complications of portosystemic shunts in patients with chronic hepatic diseases. In this cross sectional study, from summer 2000 to spring 2004, carried out at General and Vascular Surgery Departments 19 patients with portal hypertension underwent surgery. Patients with portosystemic shunts were followed up for at least one year after surgery, considering blood flow in anastomosis, using color Doppler ultrasonography and symptoms such as gastro intestinal bleeding, hepatic encephalopathy and etc. Data were analyzed using SPSS version 13 and descriptive statistics. Male to female ratio was 1:1.7. Portosystemic shunt was performed for 16 patients [2 distal splenorenal, 10 central splenorenal, 2 portocaval, 2 mesocaval] and 3 underwent splenectomy. Of patients 2 complicated with pneumonia after a week, and 2 with encephalopathy. After at least one year, 66.6% of shunts were patent, 8% were closed and in 25.4% doppler ultra sonography could not localize the shunt. One patient died under surgery. There was no death at the end of the first year; but during a 6 years follow up, 6 mortalities occurred. The major etiology of portal hypertension in these patients was cirrhosis secondary to hepatitis B. This finding is due to the cultural and religious differences with other countries. There was no relationship between pneumonia and splenectomy [p= 0.45]. Also, no significant difference observed between pre and post surgery encephalopathy [p =0.14]. Mortality rate did not depend on pre [p= 0.09] and post [p= 0.11] surgery encephalopathy. Survival rate of patients was 94.7% after one year and 73.7% after 2 years, demonstrating better results in comparison with other similar studies
RESUMO
Arteriovenous fistulae are the principal chronic hemodialysis access in patients with end stage renal disease. There is an increasing number of patients who need AVF closure because of serious complications or renal function retrieval by transplantation. Multiple open and endovascular techniques have been proposed for AVF closure. In this study, we are going to compare two surgical methods and select the preferred one as the standard technique for closure. A randomized controlled clinical trial was designed. 140 patients were randomly assigned into two matched groups. 70 patients underwent AVF ligature and the other 70 subjects underwent transvenous endorrhaphy. Each patient was followed for at least 6 months to monitor surgical results. Of 140 patients, 26 [18.6%] AVF closures were failed during 6 months of follow up. Of 26 failed cases, 24 had undergone AVF ligature. Thrill recurrence and closure failure was 37.1% in the ligature group and 2.9% in the endorrhaphy group. Transvenous endorrhaphy is associated with better AVF closure results. Therefore, we recommend this procedure as the standard technique of AVF closure