Morphological and hemodynamic changes in the portal venous system after distal splenorenal shunt: An ultrasound and pulsed doppler study

Abstract

We investigated a group of patients who underwent distal splenorenal shunt using high-resolution real-time equipment and a duplex scanner with the aims: (i) to evaluate the rate of visualization of shunt; (ii) to assess change in size in the portal vein, and (iii) to characterize the flow pattern in the splenic vein and to study flow direction and velocity in the portal vein, thus adding new data on the efficacy of this operation in maintaining hepatic perfusion. Real-time ultrasonography was performed in 29 patients before surgery, after 7 to 30 days and after 4 to 12 months. Direct visualization of the shunt was achieved in 53.5% of the patients. Mean caliber of the portal vein significantly decreased after the operation: preoperative = 1.52 +/- 0.32; after 7 to 30 days = 1.32 +/- 0.16 (p less than 0.001), and after 4 to 12 months = 0.99 +/- 0.19 (p less than 0.001). The overall postoperative incidence of portal thrombosis was 22.2%. Thirteen of these patients also underwent a postoperative (4 to 36 months) pulsed Doppler investigation. Flow towards anastomosis was demonstrated in the splenic vein in 11 patients, and in 7 cases, typical caval pulsatility was observed. Decreased hepatopetal flow in the portal vein was found in 10 of 13 patients. In two patients, no flow was detectable and in the other the flow was hepatofugal. On the basis of our data, we can affirm that pulsed Doppler investigation may provide useful data for the evaluation of shunt patency and preservation of a decreased portal hepatic perfusion in the majority of patients.

Long–Term Effects of Distal Splenorenal Shunt on Hepatic Hemodynamics and Liver Function in Patients With Cirrhosis: Importance of Reversal of Portal Blood Flow

“…No portal-vein thrombosis was found in this series. The incidence of reversal of portal flow in our series was higher than that reported by Bolondi et al (29). We believe this may reflect the fact that our study was performed in patients with a longer follow-up after DSRS.…”

Color Doppler sonography in spontaneous splenorenal portosystemic shunts.

“…Marked tortuosity and venous enlargement on imaging studies may be useful in diagnosing spontaneous splenorenal shunts. 7 Unfortunately, these characteristics are by no means definitive. Large perisplenic vessels may occur in patients without splenorenal shunts, and splenorenal shunts may occur in the absence of tortuosity and enlargement.…”

Color Doppler Evalua Tion of Hepatic Vess Els and Portal Venous System in Liv Er Diseases With Pat Hological Cprrelatio N

“…Clot detection by gray-scale imaging is difficult when the thrombus is hypoechoic. 4 HEPATIC ARTERY: Proximal hepatic artery is best seen at celiac trunk while distal hepatic artery is seen at the level of main portal vein. On Doppler assessment low resistant waveform pattern is seen with systolic and diastolic component.…”