Percutaneous transhepatic portography in the assessment of portal hypertension

Smith‐Laing, G.; Camilo, M.E.; Dick, Robert; Sherlock, Sheila

doi:10.1016/0016-5085(80)90565-x

Cited by 83 publications

(12 citation statements)

References 21 publications

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Section: Discussionmentioning

confidence: 99%

“…Many kinds of collaterals develop in patients with portal hypertension for reduction of high portal pressure 1–7 . In terms of the direction of blood flow, these collaterals can be divided into two groups: (i) descending collaterals from portal veins such as gastro‐renal or spleno‐renal shunts; 12,22 and (ii) ascending collaterals from portal veins such as esophageal varices or para‐ECV 1–13,23 . While previous studies have demonstrated that gastro‐renal or spleno‐renal shunts (descending collaterals from portal vein) influence the prevention of variceal recurrence (endoscopic and hemorrhagic recurrence) after treatment for esophago‐gastric varices, 7,12 , 21 these major porto‐systemic shunts exist in less than 20% of patients with esophageal varices who have no associated fundal gastric varices 7 .…”

Section: Discussionmentioning

confidence: 99%

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Role of para‐esophageal collateral veins in patients with portal hypertension based on the results of endoscopic ultrasonography and liver scintigraphy analysis

Irisawa¹,

Obara²,

Bhutani

et al. 2003

J of Gastro and Hepatol

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Role of para‐esophageal collateral veins in patients with portal hypertension based on the results of endoscopic ultrasonography and liver scintigraphy analysis

Irisawa¹,

Obara²,

Bhutani

et al. 2003

J of Gastro and Hepatol

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“…It has been suggested that CPSE results from a shunt of a large proportion of the superior mesenteric venous blood into the systemic circulation [2,7]. The pathogenesis of CPSE is like that which occurs after a nonselective mesocaval shunt operation [8].…”

Section: Discussionmentioning

confidence: 99%

Transjugular retrograde obliteration for chronic portosystemic encephalopathy

Chikamori

Kuniyoshi²,

Shibuya

et al. 2000

Abdom Imaging

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Chronic portosystemic encephalopathy (CPSE) is uncommon, and its management has yet to be determined. We have been able to control five cases of CPSE using transjugular retrograde obliteration (TJO), and we report our clinical results with this technique. All of the five patients were suffering from cirrhosis and had gastric varices and large gastrorenal shunts. According to Sherlock's classification, the grade of encephalopathy was II in two patients, III in two, and IV in one. According to Child's classification, one had class B and four had class C cirrhosis. TJO was performed using a 6-F angiographic catheter with an occlusive balloon 20 mm in diameter. Absolute ethanol and 5% ethanolamine oleate with iopamidol were used to obliterate the gastrorenal shunt. The gastrorenal shunt was successfully obliterated, and the encephalopathy improved to grade 0 after TJO in all cases. The portal flow volume increased significantly from 542 +/- 189 to 992 +/- 139 mL/min (p < 0.01). The plasma ammonia levels before and after TJO were 189 +/- 40 and 51 +/- 23 microg/dL, and the indocyanine green retention rates at 15 min were 44 +/- 13% and 27 +/- 12%, with both changes being significant (p < 0.01). Minor complications observed were fever of over 38 degrees C and tarry stools due to hemorrhagic gastritis in one patient, which was being controlled conservatively. One patient died of hepatocellular carcinoma 27 months after TJO. The other four patients survived without recurrence of CPSE 17-74 months (44 +/- 24 months) after TJO. We conclude that TJO can be adopted as a safe and effective treatment for CPSE.

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“…Further, the possible effects of age, sex, cause of cirrhosis, and severity of liver dysfunction also seem to be small, since they were similar in the four groups we studied. We divided patients according to findings on transhepatic portography; although this method is the most useful of several angiographic techniques for visualizing the portal system, 13 it is highly invasive. Thus, we carefully performed transhepatic portography with ultrasonic guidance.…”

Section: Discussionmentioning

confidence: 99%

“…The extent of extravariceal collateral channels was evaluated by transhepatic portography, the most reliable of several angiographic techniques, such as celiac axis angiography and splenic angiography, for visualizing the portal system. 13 cirrhosis or clinical cirrhosis (physical examination, biochemical test, and/or ultrasonographic parameters), (b) prophylactic sclerotherapy, (c) transhepatic portography before sclerotherapy, and (d) serial endoscopic examinations (before sclerotherapy, 1 week after sclerotherapy, and 1 month after sclerotherapy). However, in 16 patients, the transhepatic portographs or endoscopic pictures were of poor quality.…”

Section: Introductionmentioning

confidence: 99%

Role of extravariceal collateral channels in the development of portal-hypertensive gastropathy before and after sclerotherapy

Nakayama

Iwao

Oho

et al. 1998

Journal of Gastroenterology

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We investigated whether extravariceal collateral pattern contributed to the development of portal-hypertensive gastropathy (PHG) before and after sclerotherapy. Ninety-nine patients with cirrhosis and large esophageal varices were examined in this retrospective study. They were divided into four groups according to transhepatic portographic findings: group A (with neither paraesophageal veins nor gastrorenal shunt; n = 46), group B (with paraesophageal veins; n = 27), group C (with gastrorenal shunt; n = 14), and group D (with paraesophageal veins and gastrorenal shunt; n = 12). To assess PHG, endoscopic examinations were carried out before and 1 week and 1 month after sclerotherapy. The severity of PHG was classified according to a modified McCormack's classification and scored as: absence, 0; mild, 1; severe, 2. There were no significant differences in age, sex, cause of cirrhosis, severity of liver dysfunction, and extent of esophageal varices in the four groups. The PHG score before sclerotherapy was significantly higher in group A than in either group C (P < 0.05) or group D patients (P < 0.05). The calculated, integrated incremental change in PHG score after sclerotherapy was significantly higher in group A than in group C (P < 0.01) and group D patients (P < 0.01). Although the integrated change in PHG score was lower in group B than in group A patients, the difference was not significant (P = 0.68). These results suggest that gastrorenal shunt, but not paraesophageal veins, may play a protective role in the development of PHG before and after sclerotherapy.

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Percutaneous transhepatic portography in the assessment of portal hypertension

Cited by 83 publications

References 21 publications

Role of para‐esophageal collateral veins in patients with portal hypertension based on the results of endoscopic ultrasonography and liver scintigraphy analysis

Role of para‐esophageal collateral veins in patients with portal hypertension based on the results of endoscopic ultrasonography and liver scintigraphy analysis

Transjugular retrograde obliteration for chronic portosystemic encephalopathy

Role of extravariceal collateral channels in the development of portal-hypertensive gastropathy before and after sclerotherapy

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