Portal Venous Flow Pattern as a Useful Tool for Predicting Esophageal Varix Bleeding in Cirrhotic Patients

Abstract

This study aimed to evaluate whether (1) the portal venous flow pattern determined by color Doppler sonography could be related to the clinical severity of liver cirrhosis and (2) whether the flow patterns differ between patients with bleeding and nonbleeding esophageal varices. One hundred twenty-nine cirrhotic patients and 60 noncirrhotic healthy controls were enrolled after endoscopic survey for the presence of esophageal varices. Each patient received color Doppler echography to define the pattern of blood flow direction as hepatopetal or nonhepatopetal (hepatofugal, turbulence, and bidirection) in type. The patients with esophageal varices were further categorized into two groups: with recent bleeding (BEV; n = 99) and without recent bleeding (NBEV; n = 30). More patients in the BEV group (72.7%) had a nonhepatopetal Doppler flow pattern than in the control group (1.7%) and NBEV group (13.3%) (P < 0.001). Among the 129 cirrhotic patients, the nonhepatopetal flow pattern of the portal vein was higher in 96% of Child-Pugh grade C patients than in 41.8% of grade A patients and 57.6% of grade B patients (P < 0.05). Moreover, for those cirrhotic patients with Child-Pugh grades A and B, the nonhepatopetal Doppler flow pattern was more commonly found in the BEV group than in the NBEV group (63.0 vs. 13.8%; odds ratio, 10.64; 95% CI, 0.03-0.299; P < 0.001). Portal venous blood flow pattern is related to severity of cirrhosis. The presence of a nonhepatopetal flow pattern implicates an increased risk of esophageal varices bleeding, especially for those cirrhotic patients with Child-Pugh grades A and B.

Four-dimensional Flow MRI as a Marker for Risk Stratification of Gastroesophageal Varices in Patients with Liver Cirrhosis

“…Although some collaterals, including the coronary vein, were too small to be directly viewed at 4D flow MRI, the decrease of flow in the PV because of hepatofugal shunting of blood was sufficient to help detect abnormal flow to the varices. Previous studies showed that flow measurement by using US in the PV (29,30) or in the hepatic veins (31) can be used to predict the presence of varices. Although US-based flow measurement is simpler and less expensive than MRI, it is challenging to measure the flow in the hepatic vasculature at US because of the complexity of anatomy and limited field of view.…”

Noninvasive predictors of large varices in patients hospitalized with gastroesophageal variceal hemorrhage

“…Investigators have attempted to identify characteristics that noninvasively predict the presence of varices. These studies have shown that biochemical, clinical, and ultrasonographic parameters alone or together have good predictive power for noninvasively assessing the presence of EV [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Overall, the most common result of these studies was that parameters such as splenomegaly, thrombocytopenia, Childs score, ascites, portal flow patterns, and platelet count-splenic size ratio were predictors of the presence of EV.…”

Hemodynamic consequences of spontaneous splenorenal shunts in deceased donor liver transplantation

“…3,[5][6][7][8][9] Not infrequently, this is associated with PV thrombosis. [10][11][12] However, large portosystemic shunts such as SSRSs may jeopardize the portal flow and lead to graft dysfunction due to portal hypoperfusion. 13 The optimal surgical approach to SSRSs has not been well defined.…”