2020
DOI: 10.1177/1756284820961287
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Spontaneous portosystemic shunts in liver cirrhosis: new approaches to an old problem

Abstract: Portal hypertension is the main consequence of liver cirrhosis, leading to severe complications such as variceal hemorrhage, ascites or hepatic encephalopathy. As an attempt to decompress the portal venous system, portal flow is derived into the systemic venous system through spontaneous portosystemic shunts (SPSSs), bypassing the liver. In this review, we aim to provide an overview of the published reports in relation to the prevalence and physiopathology behind the appearance of SPSS in liver cirrhosis, as w… Show more

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Cited by 35 publications
(29 citation statements)
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References 117 publications
(312 reference statements)
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“…These contrasting findings can be explained by the dynamic nature of liver cirrhosis which goes through different stages and is affected by different compensatory mechanisms [ 50 ]. In the first functional pathophysiology, SPSS could represent an inefficient compensatory mechanism that partially reduces portal hypertension and its complications by rerouting portal blood away from the liver.…”
Section: Types Of Shunts and Their Reported Clinical Associationsmentioning
confidence: 99%
See 1 more Smart Citation
“…These contrasting findings can be explained by the dynamic nature of liver cirrhosis which goes through different stages and is affected by different compensatory mechanisms [ 50 ]. In the first functional pathophysiology, SPSS could represent an inefficient compensatory mechanism that partially reduces portal hypertension and its complications by rerouting portal blood away from the liver.…”
Section: Types Of Shunts and Their Reported Clinical Associationsmentioning
confidence: 99%
“…Nardelli and colleagues found that the presence of SPSS on CT images in patients with cirrhosis was associated with higher mortality and complications, including HE, variceal bleeding, and portal vein thrombosis [46]. ese contrasting findings can be explained by the dynamic nature of liver cirrhosis which goes through different stages and is affected by different compensatory mechanisms [50]. In the first functional pathophysiology, SPSS could represent an inefficient compensatory mechanism that partially reduces portal hypertension and its complications by rerouting portal blood away from the liver.…”
Section: Complications Related To Spssmentioning
confidence: 99%
“…The presence of SPSS in this population could be explained only if we consider liver cirrhosis as a dynamic disease with different stages and compensatory mechanisms. [24] In the first phase of this pathophysiological functional view of liver disease, SPSS could represent a compensatory measure that reduces portal hypertension and its complications, while in the advanced phase SPSS reduce liver perfusion and can determine liver failure.…”
Section: Discussionmentioning
confidence: 99%
“…Portosystemic shunts are aberrant vascular communications between the portal venous system and lower-pressure systemic veins. As blood bypasses the liver, neurotoxins and vasoactive substances travel to the brain and lung, and predispose the patient to the development of hepatic encephalopathy, HPS, and portopulmonary hypertension [3] .…”
Section: Discussionmentioning
confidence: 99%