Detection of paraumbilical or splenorenal shunts by intra-arterial-DSA in bleeding varices: another risk factor?

In six of 46 consecutive patients with liver cirrhosis and bleeding varices, selective intra-arterial digital subtraction angiography detected large spontaneous portosystemic shunts including three patent paraumbilical veins and three splenorenal shunts. Twenty-one patients died during a median 73-month follow up period after devascularization with (44 cases) or without (2 cases) esophageal transection. Univariate analysis of preoperative variables concerning hepatic reserve failed to show significant predictability on postoperative survival rate. Instead, the postoperative survival rate of patients with the decompressive shunts was significantly lower than that of patients without the shunt. In a subgroup of patients with well-compensated liver cirrhosis and bleeding varices, the coexistence of paraumbilical or splenorenal portosystemic shunt may be another potent variable predicting poor prognosis.