Die kontrollierte arterialisation der leber

Abstract

The effects of portacaval shunt with and without arterialization of the hepatic portal vein were studied in dogs. An end-to-side portacaval shunt was performed in all animals, and in one group this was followed by the interposition of an external jugular vein graft between the hepatic stump of the portal vein and the abdominal aorta. The dogs were observed over a period of 10 weeks.Portocaval shunt alone caused a decrease in liver blood flow from 38.5 ± 13.3 to 10.5 + t.7 ml/kg/min (P < 0.001), hepatic atrophy, impaired indocyanin green clearance from 101 _+ 022 to 053 _+ 014 (P < 0.001) and increased concentrations of ammonia from 48 + 13 to 155 ± 36 (P < 0.001) and bile acids from 3 ± 2 to 239 _+ 93 (P < 0.001) in the peripheral blood.These effects were prevented by arterilization of the liver. Thrombosis of the arterial graft and increase in intrahepatic blood pressure were the two major complications of arterialization which were observed.These findings indicate that depriving the liver of portal blood causes pathophysiological changes which may be responsible for the well known complications of liver failure and encephalopathy observed following portocaval anastomosis in cirrhotic patients. The fact that arterialization of the portal vein minimizes these changes encourages the application of this procedure in the treatment of portal hypertension in man. Key words: Portacaval Shunt --Arterialization of the Liver.Zusammen/assung. Die pathophysiologischen Ver~nderungen des portocavalen Shunt und der Einflul] der Arterialisation der Leber auf diese Mechanismen wurden an Hunden untersucht. Ein portocavaler End-zu-Seit-Shunt wurde bei allen Tieren durchgeffihrt. In einer Gruppe wurde durch Interposition der V. jugularis externa zwischen dem Stumpf der Pfortader und der Aorta abdominalis eine druck-und durchfluBkontrollierte Arterialisation der Leber angeschlossen. Die Tiere wurden l0 Wochen beobachtet.Der portocavale Shunt fiihrte zu einer Reduktion des Leberblutflusses yon 38,5 + 13,3 auf 10,5 _+ 1,7 ml/kg/min (P < 0,001) zur Atrophic der Leber, zur Ein-22*

Portal Vein Arterialization Increases Hepatocellular Apoptosis and Inhibits Liver Regeneration

“…Clinically it was introduced in patients with portal hypertension due to liver cirrhosis. A portocaval shunt was combined with portal vein arterialization to ensure adequate blood flow to the liver [1][2][3][4][5]. In orthotopic and heterotopic liver transplantation, permanent portal vein arterialization was performed in patients with insufficient portal flow to the graft (caused by portal vein thrombosis, extended portosystemic collateral veins, or a "portal blood steal" phenomenon in auxiliary liver transplantation) [6 -13].…”

Improved microcirculation of a liver graft by controlled portal vein arterialization

“…Increased portal blood flow and portal blood pressure effected the portal vein (dilatation, aneurysm formation, portal vasculitis) and the liver parenchyma (loss of function, fibrosis, cirrhosis) [22][23][24][25][26]. On the other hand, Fisher [27], Funovics [28], and Asakawa [29] did not find any morphological changes of the liver after flow-controlled arterialization of the portal vein in association with a porto-caval shunt in dogs.…”