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The authors describe 4 patients who had functioning distal splenorenal shunts despite obstruction of the left renal vein at its insertion into the inferior vena cava. The angiographic technique and findings of left renal vein evaluation in 40 shunted patients are reviewed. There were two important findings. First, no correlation existed between the degree of portal hypertension and the degree of filling of collateral tributaries of renal veins. Second, obstruction of the left renal vein does not impair a splenorenal shunt if good collateral pathways are present.
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