Portal venous system after portosystemic shunts or endoscopic sclerotherapy: evaluation with Doppler sonography.

Rice, Stephanie; Lee, K P; Johnson, M B; Korula, Jacob; Ralls, Philip W.

doi:10.2214/ajr.156.1.1898575

Cited by 13 publications

(3 citation statements)

References 14 publications

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“…14 In addition, all EVT techniques may modulate portal venous hemodynamics while blocking varicose veins, manifesting as an increased portal vein blood flow [23][24][25] and a turbulence to the blood flow within the portal venous system. 26 Indeed, the present study also found that EVT mainly increased the risk of thrombosis within extrahepatic portal vein system vessels (i.e. MPV, SMV, and SV), but a mild impact on thrombosis within intrahepatic portal vein branches (i.e.…”

Section: Discussionsupporting

confidence: 70%

Association of endoscopic variceal treatment with portal venous system thrombosis in liver cirrhosis: a case–control study

Wang

Guo

Shao

et al. 2022

Therap Adv Gastroenterol

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Background: The association of endoscopic variceal treatment (EVT) with portal venous system thrombosis (PVST) in liver cirrhosis is still unclear. Methods: PVST was assessed by contrast-enhanced CT or MRI in 406 cirrhotic patients from our prospective database. Case and control groups, which are defined as patients with and without PVST, respectively, were matched at a ratio of 1:1 according to age, gender, Child-Pugh class, and MELD score. History of EVT was reviewed. Logistic regression analysis was used to identify the risk factors for PVST. Odds ratios (ORs) were calculated. Subgroup analyses were further performed in terms of degree and location of PVST. Results: Overall, 109 patients each were included in case and control groups. The case group had a significantly higher proportion of patients who had undergone EVT than the control group (53.2% versus 18.3%; p < 0.001). In detail, the case group had significantly higher proportions of patients who had undergone EVT for controlling bleeding (45.9% versus 14.7%; p < 0.001), endoscopic variceal ligation (EVL) alone (19.3% versus 9.2%; p = 0.033), and EVL combined with endoscopic cyanoacrylate glue injection (24.8% versus 5.5%; p < 0.001). EVT was independently associated with PVST (OR = 4.258; p < 0.001). In subgroup analyses, EVT remained independently associated with partial PVST (OR = 10.063; p < 0.001), complete PVST/fibrotic cord (OR = 4.889; p = 0.008), thrombosis within main portal vein (OR = 5.985; p < 0.001), and thrombosis within superior mesenteric and splenic veins (OR = 5.747; p < 0.001). Conclusions: EVT may lead to a higher risk of PVST, especially more severe PVST, in liver cirrhosis. Screening for and prophylaxis of PVST after EVT should be further explored.

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Section: Discussionsupporting

confidence: 70%

Association of endoscopic variceal treatment with portal venous system thrombosis in liver cirrhosis: a case–control study

Wang

Guo

Shao

et al. 2022

Therap Adv Gastroenterol

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“…Secondary signs of shunt thrombosis, such as hepatopetal intrahepatic portal flow, 20 may be misleading. 21 Transjugular intrahepatic portosystemic stent shunts (TIPSS) can be evaluated with Doppler sonography. Preprocedure evaluation and post-TIPSS follow-up are useful.…”

Section: Therapeutic Portosystemic Shuntsmentioning

confidence: 99%

Sonography of Diffuse Liver Disease

Tchelepi

Ralls

Radin

et al. 2002

Journal of Ultrasound in Medicine

248

187

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Sonography is often the first imaging procedure performed in the evaluation of individuals with suspected liver disease. Evaluation for biliary dilatation is always performed, because bile duct obstruction can cause abnormal liver test results, raising the suspicion of liver disease. Ultrasound is a useful but imperfect tool in evaluating diffuse liver disease. We discuss the uses and limitations of sonography in evaluating parenchymal liver disease. Sonography can show hepatomegaly, fatty infiltration of the liver, and cirrhosis, all with good but imperfect sensitivity and specificity. Sonography is of limited usefulness in acute hepatitis. Increased parenchymal echogenicity is a reliable criterion for diagnosing fatty liver. Cirrhosis can be diagnosed in the correct clinical setting when the following are present: a nodular liver surface, decreased right lobe-caudate lobe ratio, and indirect evidence of portal hypertension (collateral vessels and splenomegaly). Ultrasound plays an important role in the imaging of conditions and procedures common in patients with diffuse liver disease.

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“…Hepatofugal portal flow is observed under various conditions. Most reports of hepatofugal portal flow have been in patients with cirrhosis3 or in those who have undergone portosystemic shunt procedures 4,5. There are few reports of hepatofugal portal flow after surgery other than portosystemic shunt procedures 6.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Sugimoto

Kaneko

Marui

et al. 2001

J Hep Bil Pancr Surg

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Portal hepatofugal flow is rare after liver transplantation. We experienced a case in which hepatofugal portal flow was observed in acute rejection. A 6-year-old boy with glycogen storage disease type Ia underwent living-donor liver transplantation. On postoperative day 7, portal venous peak velocity was markedly decreased without portal thrombosis and obstruction of the hepatic vein, and hepatic arterial peak velocity increased reciprocally. Based on a diagnosis of acute rejection, made on postoperative day 8, we initiated steroid pulse therapy. Despite the employment of this therapy, continuous hepatofugal portal flow was observed in the entire liver on postoperative day 8. On day 12, as the liver disorder progressed, the Doppler waveform in the portal vein changed from continuous to pulsatile hepatofugal flow. The patient died of liver failure on day 14. The histological findings of a biopsy specimen on day 9 showed centrilobular necrosis, while total hepatocellular necrosis was seen at autopsy. Hepatofugal flow after liver transplantation is considered to be an ominous sign caused by several factors, and its appearance indicates a fatal condition.

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Portal venous system after portosystemic shunts or endoscopic sclerotherapy: evaluation with Doppler sonography.

Cited by 13 publications

References 14 publications

Association of endoscopic variceal treatment with portal venous system thrombosis in liver cirrhosis: a case–control study

Association of endoscopic variceal treatment with portal venous system thrombosis in liver cirrhosis: a case–control study

Sonography of Diffuse Liver Disease

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