Doppler analysis of hepatic blood flow predicts liver dysfunction after major hepatectomy

Abstract

In 17 consecutive patients who underwent major hepatic resection, 9 of whom with combined resection of the gastrointestinal tract or the pancreatic head (or both), postoperative hepatic blood flow was investigated. In this study, the patients were classified into two groups according to their postoperative serum total bilirubin level: Group A comprised 7 patients with the level higher than 7 mg/dl for more than 1 week postoperatively, and group B comprised 10 patients who did not meet this criterion. For 2 weeks after surgery, the portal blood flow velocity, the hepatic artery resistive index (RI) calculated from the changes in Doppler frequency shifts, and the hepatic venous blood flow velocity were measured intermittently using color Doppler ultrasonography. Liver volume was assessed by computed tomography to provide the restoration. Significant differences in portal blood flow velocity and hepatic artery RI were noted between the two groups from the third postoperative day. In group A the portal blood flow velocity decreased below the preoperative value, and the hepatic artery RI increased above 0.75. In contrast, group B showed high portal blood flow velocity and low hepatic artery RI. In both groups the RI correlated significantly with the total bilirubin level (r = 0.74; p < 0.0001), and the growth rate of the remnant liver was proportional to the mean postoperative portal blood flow velocity (r = 0.70; p = 0.016). We concluded that measurement of the portal blood flow velocity and hepatic artery RI can be useful for predicting postoperative liver dysfunction and liver regeneration after major hepatic resection.

How Much Remnant Is Enough in Liver Resection?

“…Following hepatectomy, the loss of liver functional mass and vascular capacity result in a marked increase in hepatic artery resistance and an increase in portal vein pressure [71]. Excessive portal vein pressure may result in microcirculatory collapse, sinusoidal endothelial damage, Kupffer cell injury and subsequent lack of hepatocyte regeneration up to liver atrophy [72].…”

Limits of and Complications after Embolization of the Hepatic Artery and Portal Vein to Induce Segmental Hypertrophy of the Liver: A Large Mini-Pig Study

“…As a second mechanism, hemodynamic changes with an upregulation of portal flow are known to regulate liver regeneration and hypertrophy. Several studies have shown that the degree of hypertrophy is directly correlated with the increase in portal flow [14,15,16,17,18,19,20], whereas the rate of hypertrophy and liver regeneration are directly related to the degree of atrophy of the occluded liver lobe without a change in the total liver volume [21,22,23]. Besides the increase in portal vein flow, different authors described an inverse significant reduction in arterial flow, which has been described as hepatic arterial buffer response (HABR) [20,21,24,25].…”

Postprandial Responses of Liver Blood Flow Prior to and Following Hepatectomy in Conscious Dogs

“…Zero calibration was confirmed when the blood flow is important for preventing liver failure fol-probes were excised. Data were recorded on a polygraph system lowing a liver resection [3]. Feeding is one of the most (A601, Nihon Koden, Tokyo, Japan) and a direct writing recorder (TI-250, Tokai Irika, Tokyo, Japan).…”