Portal hypertension: a review of portosystemic collateral pathways and endovascular interventions

Pillai, Anil K.; Andring, Brice; Patel, Amish; Trimmer, Clayton; Kalva, Sanjeeva P.

doi:10.1016/j.crad.2015.06.077

Cited by 44 publications

(27 citation statements)

References 65 publications

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“…Esophago-gastro-duodenoscopy, the gold standard test for diagnosing gastroesophageal varices classifies them according to size as small (< 5 mm) or large (> 5 mm) [ 7 ]. Endoscopic ultrasonography (EUS) can additionally assess collateral pathway anatomy and identify of perforating veins which improves treatment response monitoring in real-time [ 5 , 7 , 8 ]. Nonetheless, EUS is not recommended as the primary tool for assessment due to limited availability and need for expertise.…”

Section: Diagnosismentioning

confidence: 99%

“…These include the Iwase and Arakawa classifications, the Japanese Society for Portal Hypertension (JSPH) modification of the Hashizume classification, and the Italian Endoscopic Classification. Another simple classification differentiates GV into primary and secondary, the latter occurring after band ligation and eradication of esophageal varices (Additional file 1 : Table 1) [ 5 , 7 , 8 ].…”

Section: Diagnosismentioning

confidence: 99%

“…These are the gastroesophageal system, between the left gastric vein and the azygous vein and the gastrophrenic system between the gastric veins in the posterosuperior gastric wall; and left inferior phrenic vein at the gastrophrenic ligament near the bare area of the stomach. In isolated splenic vein thrombosis, the collateral circulation pathways form in hepatopetal manner [ 8 ].…”

Section: Diagnosismentioning

confidence: 99%

“…As the severity of PH increases, the shunt flow increases, and the shunt grows and travels caudally and posteriorly, reaching the retroperitoneal and other regions sometimes undergoing duplication at the site of drainage. Understanding the complex anatomy of the GV system and associated hemodynamic classifications are significant in planning a multitude of managements for bleeding GV such as endoscopic cyanoacrylate therapy only or shunt occlusion with or without variceal embolization, endoscopic ultrasound-guided coiling or transjugular intrahepatic portosystemic shunt placement [ 7 , 8 , 14 – 16 ].…”

Section: Diagnosismentioning

confidence: 99%

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Beyond the scope and the glue: update on evaluation and management of gastric varices

et al. 2020

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Gastric varices are encountered less frequently than esophageal varices. Nonetheless, gastric variceal bleeding is more severe and associated with worse outcomes. Conventionally, gastric varices have been described based on the location and extent and endoscopic treatments offered based on these descriptions. With improved understanding of portal hypertension and the dynamic physiology of collateral circulation, gastric variceal classification has been refined to include inflow and outflow based hemodynamic pathways. These have led to an improvement in the management of gastric variceal disease through newer modalities of treatment such as endoscopic ultrasound-guided glue-coiling combination therapy and the emergence of highly effective endovascular treatments such as shunt and variceal complex embolization with or without transjugular intrahepatic portosystemic shunt (TIPS) placement in patients who are deemed ‘difficult’ to manage the traditional way. Furthermore, the decisions regarding TIPS and additional endovascular procedures in patients with gastric variceal bleeding have changed after the emergence of ‘portal hypertension theories’ of proximity, throughput, and recruitment. The hemodynamic classification, grounded on novel theories and its cognizance, can help in identifying patients at baseline, in whom conventional treatment could fail. In this exhaustive review, we discuss the conventional and hemodynamic diagnosis of gastric varices concerning new classifications; explore and illustrate new ‘portal hypertension theories’ of gastric variceal disease and corresponding management and shed light on current evidence-based treatments through a ‘new’ algorithmic approach, established on hemodynamic physiology of gastric varices.

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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

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Beyond the scope and the glue: update on evaluation and management of gastric varices

et al. 2020

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“…Abdominal veins may serve as collateral channels within the systemic circulation[ 7 ]. The presence of portosystemic collateral veins (PSCVs) is common in portal hypertension, which is defined as blood flow through a vessel or a vascular bed that is obstructed due to occlusion, as in extrahepatic portal vein obstruction (EHPVO), or distorted, as in liver cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Devascularization of the superior mesenteric vein without reconstruction during surgery for retroperitoneal liposarcoma: A case report and review of literature

Miao

Wan

Zhang

et al. 2018

WJG

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A 61-year-old female patient with chronic hepatitis B virus infection was diagnosed with liposarcoma in a community hospital. Fine needle aspiration biopsy confirmed the diagnosis of well-differentiated liposarcoma. Abdominal computed tomographic angiography (CTA) showed that the mass adhered to and constricted the main trunk and branch of the superior mesenteric vein (SMV), especially the ileocolic vein, and collateral circulation was observed during the vascular reconstruction scan. The abdominal liposarcoma was resected. Because of the collateral circulation, devascularization of the SMV was attempted, and we resected the eroded SMV. The condition of the blood vessels was evaluated 20 d after surgery using CTA, which showed that the SMV had disappeared. Significant improvements in SMV collateral circulation and the inferior mesenteric vein were observed after vascular reconstruction. The patient had an uneventful postoperative course except for transient gastroplegia. Twenty months after surgery, the patient had a recurrence of liposarcoma. She underwent tumor resection to remove the distal small intestine and right hemicolon. We learned that (1) direct devascularization of the main SMV trunk without a vein graft is possible. The presence of collateral circulation can increase the success rate of patients undergoing radical surgery and prevent the occurrence of serious postoperative complications. In addition, (2) this case demonstrated the clinical value of 3D reconstruction.

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Surgery in Patients with Hepatic Cirrhosis: Management of Portal Hypertension

Abu‐Elmagd

Soliman

Khanna

et al. 2017

Surgical Procedures on the Cirrhotic Patient

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Portal hypertension: a review of portosystemic collateral pathways and endovascular interventions

Cited by 44 publications

References 65 publications

Beyond the scope and the glue: update on evaluation and management of gastric varices

Beyond the scope and the glue: update on evaluation and management of gastric varices

Devascularization of the superior mesenteric vein without reconstruction during surgery for retroperitoneal liposarcoma: A case report and review of literature

Surgery in Patients with Hepatic Cirrhosis: Management of Portal Hypertension

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