Portal hypertension can lead to life-threatening variceal bleeding (VB). Transjugular intrahepatic portosystemic shunt (TIPSS) is the standard choice for uncontrolled VB. Unavailable for TIPSS, we design a mesofemoral shunt (MFS) as an alternative method for control of VB.
From March 2011 to November 2014, eleven patients with VB due to liver cirrhosis were enrolled. The MFS was created by connecting from superior mesenteric vein below transverse colon, via subcutaneous tunnel, to right femoral vein with an 8-mm diameter polytetrafluoroethylene (PTFE) graft.
The median follow-up was 13 months (range, 2~44 months). The MFS was successful in 11 (100%) hemostasis. One patient died of surgical mortality and the other due to liver failure 6 months after MFS. The PTFE occlusion was documented by ultrasonography in 4 (36%) patients. Two (18%) developed recurrent bleeding, which was treated by surgical thrombectomy. Nine patients, including 2 bridged to LT, were alive.
The MFS is an effective and considerable shunt procedure to control VB in the situation of unavailable for TIPSS. The subcutaneous tunnel of MFS could also be managed as surgical thrombectomy.