Intrahepatic Arteriovenous Shunting in Cirrhosis of the Liver

Groszmann, Roberto J.; Kravetz, David; Parysow, O.

doi:10.1016/s0016-5085(19)32310-8

Cited by 39 publications

(9 citation statements)

References 7 publications

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“…Presumably this pathway also can account for the arteriovenous shunting of blood observed in cirrhotic livers. [46][47][48] The hepatic artery compartmentalization diagram shows that inflows to the lobule contain no direct input from the artery; i.e., the sinusoids receive literally secondhand blood. In other words, nowhere are the hepatocytes bathed with firsthand, pure arterial blood.…”

Section: Morphological Considerationsmentioning

confidence: 99%

The isolated artery: An intrahepatic arterial pathway that can bypass the lobular parenchyma in mammalian livers

Ekataksin

2000

Hepatology

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Controversy persists concerning the distribution of intrahepatic arterial termination. Apart from nourishing structures in the portal tract, several authors have suggested arterial supply to some isolated vascular beds that bypass the parenchyma, but this was not verified morphologically. In the present study, the existence of an isolated hepatic artery unaccompanied by a portal vein or a bile duct was shown in livers of pigs and other mammals including the dog, seal, ox, horse, and man. After colored media injection, liver blocks were sampled near the hepatic capsule and hepatic vein and subject to histologic assessment. The hepatic artery dissociated from superficial portal tract, ramified, and anastomosed extensively, forming a capsular plexus that drained at places into peripheral sinusoids in which resistive structural elaborations were observed. The artery also dissociated and fed an intramural plexus (vasa vasorum) of hepatic veins. This was collected into a vessel that penetrated the intima into the vein's lumen. In smaller sublobular veins, the plexus emptied into adjacent sinusoids; in central veins, the plexus was poorly developed. In canine and phocine livers, which have a special throttling musculature in sublobular veins, the isolated arterioles were numerous; in bovine and equine livers, which have a thick fibrous investment, the capsular plexus was welldeveloped. Occurrence of the isolated artery also was confirmed in the human but not in the rodent liver. In conclusion, the isolated artery is responsible for isolated vascular beds, in which the transintimal pathway can bypass the lobular sinusoids. (HEPATOLOGY 2000;31:269-279.)There is no definite consensus concerning the distribution and functions of the hepatic artery. Intrahepatic termination of the arteria hepatica propria has been a controversial issue for more than a century. 1 Review of the literature shows that the subject became controversial in 1866, when Chrzonszczewsky, 2 with his classic experiments of selective ligation and injection, observed that branches of the hepatic artery penetrated into the depth of the lobule, and concluded subsequently that the artery nourished the central half of the liver lobule, whereas the portal vein supplied the peripheral half. One hundred years later, in 1966, not only were the statements unsupported, but also many studies extended the controversy about the anatomy 3-7 and physiology 8,9 of intrahepatic arterial distribution. As a result, the clinical and pathological significance of the hepatic artery has remained ill defined, because how the vessel ramifies in the liver has not been accurately described. 10 Microscopic terminations of the hepatic artery are classified into 2 categories, within the portal tract and outside of the portal tract. The former is associated with the formation of periductal plexus and arterioportal anastomosis, 11 whereas the latter is typically related to the distribution of intralobular arterioles. 12 It is the second category that has been most argued. From time to t...

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Section: Morphological Considerationsmentioning

confidence: 99%

The isolated artery: An intrahepatic arterial pathway that can bypass the lobular parenchyma in mammalian livers

Ekataksin

2000

Hepatology

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“…Harbin et al 13 Functional blood-flow studies in patients with cirrhosis documented the shunting of blood away from the hepatic parenchyma and into the caval circulation. 15,16 These microcirculatory shunts, which form within the portal venous system as well as between the hepatic arterial and hepatic venous systems, result in markedly decreased blood flow to the hepatic parenchyma. 15,16 Starzl et al 17 demonstrated the existence of several hepatotropic factors, insulin being 1 of the most important, that enter the liver via the splanchnic circulatory system.…”

Section: Discussionmentioning

confidence: 99%

Correlation of MRI liver volume and Doppler sonographic portal hemodynamics with histologic findings in patients with chronic hepatitis C

Barbaro

Manfredi

Bombardieri

et al. 2000

J. Clin. Ultrasound

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Purpose The purpose of this study was to correlate portal hemodynamics on sonography and liver volume on MRI with histologic findings in asymptomatic patients with chronic hepatitis C. Methods Portal blood flow in the left and right portal branches in 20 healthy volunteers and in 26 patients was measured using Doppler sonography during both fasting and postprandial states. Total liver and right‐and left‐lobe volumes were determined using MRI. The ratio between portal blood flow and liver volume determined the “portal flow index” of the right and left lobes. Results We observed a statistically significant difference (p < 0.01) between the volunteers and patients in the mean left‐lobe volume (352 ± 81 cm3 versus 544 ± 159 cm3) and in the mean left portal flow index (1.1 ± 0.2 ml/minute/cm3 versus 0.69 ± 0.2 ml/minute/cm3) as measured before the subjects ate. After a meal, the portal blood‐flow volume in the right lobe was similar in the 2 groups but in the left lobe was significantly lower in the patients (p = 0.0009). The left postprandial portal flow index was inversely correlated with the grade of liver fibrosis (r = 0.533). Conclusions The left‐lobe volume (positive predictive value, 83%; negative predictive value, 72%) and left postprandial portal flow index (positive predictive value, 86%; negative predictive value, 88%) are sensitive indicators of chronic hepatitis. The left postprandial portal flow index may be a useful test for differentiating patients with minimal or no fibrosis from patients with mild to severe fibrosis. © 2000 John Wiley & Sons, Inc. J Clin Ultrasound 28:461–468, 2000.

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“…Opinions have differed as to whether the decreased liver uptake seen in alcoholics is caused by shunts or by decreased RE function. CASTELL et al (3), GROSZMANN et al (14), and HORISAWA et al (16) consider that the increased bone marrow uptake is caused mainly by liver shunts through which the radiocolloids can bypass the liver sinusoids. LAHNBORG et al (19) found de creased total RES function in patients with alcoholic liver disease due to depressed Kupffer cell function.…”

Section: Discussionmentioning

confidence: 99%

Bone Marrow Extension and Pelvic Bone Marrow Activity in Alcoholic Liver Disease

Rudberg¹

1992

Acta Radiol

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Red bone marrow extension and increased central bone marrow activity were found in 21 patients with alcoholic liver disease investi gated with scintigraphy of the reticuloendothelial system. The pa tients had no concurrent disease known to alter red bone marrow distribution. The bone marrow extension and the increased pelvic bone marrow activity may be explained as being secondary to a decreased radiocolloid uptake in the liver and could thus be a sign of decreased reticuloendothelial capacity.

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Intrahepatic Arteriovenous Shunting in Cirrhosis of the Liver

Cited by 39 publications

References 7 publications

The isolated artery: An intrahepatic arterial pathway that can bypass the lobular parenchyma in mammalian livers

The isolated artery: An intrahepatic arterial pathway that can bypass the lobular parenchyma in mammalian livers

Correlation of MRI liver volume and Doppler sonographic portal hemodynamics with histologic findings in patients with chronic hepatitis C

Bone Marrow Extension and Pelvic Bone Marrow Activity in Alcoholic Liver Disease

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