[Possible causes of thrombus-related hazard of a distal splenorenal venous anastomosis].

A distal splenorenal venous anastomosis (DSRVA) is used as a method to decompress the portal system in hypertension and as a method to treat type 1 diabetes mellitus. The essence of the operation consists in establishing an «end-to-side» anastomosis between the distal end of the transected close to the ostium splenic vein with the left renal vein. Possible shortcomings of this operation include but are not limited to high thrombus-related hazard both in case of using it in portal hypertension and in diabetes mellitus. In the latter, thrombosis of the anastomosis is observed to develop in 27% of diabetic patients within 7-8 postoperative months. The causes of this complication were not studied. The present communication presents the findings of studying the natural pattern of confluence of the portal-system veins performed on a total of 111 cadavers and in 50 patients suffering from chronic hepatitis and undergoing surgery in order to form a left-sided renoportal venous anastomosis. It was demonstrated that DSRVA is associated with impaired natural confluence of the veins and the width of the two veins forming an anastomosis exceeds the width of the blood-outflowing vein more than 1.5-fold. This is followed by analysing the results of studying removability of the pancreas and left kidney in the vertical position by means of excretory urography and probe-assisted duodenography in 54 patients with chronic hepatitis. Removability of the pancreas in 57.4% of cases was greater than that of the left kidney, which is the condition for kinking of the splenic vein in the DSRVA zone. In order to choose an optimal anastomosis and to prevent DSRVA thrombosis it is advisable to preoperatively examine the venous pressure in the left renal vein, removability of the pancreas relative to the left kidney, and during establishing the anastomosis to observe the natural pattern of confluence of veins by the width.