Portal Hypertension and Portacaval Shunt**Supported by NIH Grants A3048, A5919, AM07315, AM07511, AM1228, AM19875, AM12280, AM17103, and DK41920.

2001 ◽  
pp. 637-701 ◽  
Author(s):  
Marshall J. Orloff
2007 ◽  
Vol 1 (3) ◽  
pp. 279-281
Author(s):  
Geliang Xu ◽  
Hejie Hu ◽  
Jiansheng Li ◽  
Shugao Yang ◽  
Zhongpei Chai ◽  
...  

1961 ◽  
Vol 265 (15) ◽  
pp. 721-728 ◽  
Author(s):  
George E. Wantz ◽  
Mary Ann Payne

2006 ◽  
Vol 119 (20) ◽  
pp. 1727-1733 ◽  
Author(s):  
Zhong-tao ZHANG ◽  
Peng JIANG ◽  
Yu WANG ◽  
Jian-she LI ◽  
Jian-guo XUE ◽  
...  

1994 ◽  
Vol 266 (3) ◽  
pp. H1162-H1168 ◽  
Author(s):  
Z. Y. Wu ◽  
J. N. Benoit

Previous studies have suggested that the development of portal venous collaterals and subsequent portosystemic shunting is the key event responsible for the reduced vasoconstrictor effectiveness in chronic portal hypertension. The purpose of the present study was to test this hypothesis. Thirty-nine male Sprague-Dawley rats were divided into four groups: end-to-side portacaval shunt (PCS, n = 11), chronic prehepatic portal hypertension (CPH, n = 10), acute prehepatic portal hypertension (APH, n = 8), and sham-operated controls (Sham, n = 10). The small intestine was prepared for microcirculatory studies. First-order arteriolar diameter and erythrocyte velocity were measured on-line, and blood flow was subsequently calculated. Once steady-state values were obtained the preparation was topically exposed to incremental doses of norepinephrine. The half-maximal effective dosage (ED50) for maximal vasoconstriction (diameter response) was significantly increased in PCS (4.5 microM) and CPH (1.5 microM) compared with Sham (0.8 microM). However, the ED50 was significantly lower in APH (0.17 microM) than in Sham. Similarly the ED50 for maximal blood flow reduction was higher in PCS (2.4 microM) and CPH (1.2 microM) compared with Sham (0.2 microM). The results demonstrate that vascular norepinephrine responsiveness is reduced in both portacaval shunted and chronic portal hypertensive rats, but not in acute portal hypertension. These data indicate that portosystemic shunting, not portal pressure elevation, is the key event leading to the reduced vascular norepinephrine responsiveness observed in CPH conditions.


1962 ◽  
Vol 42 (5) ◽  
pp. 555-559 ◽  
Author(s):  
Peter W. Morris ◽  
T.B. Patton ◽  
J.A. Balint ◽  
B.I. Hirschowitz

1992 ◽  
Vol 33 (4) ◽  
pp. 356-359 ◽  
Author(s):  
W. Cwikiel ◽  
H. Stridbeck

A transjugular portacaval intrahepatic stented shunt was created in 16 pigs without induced portal hypertension. A fine needle (OD 0.7 mm) was used for the transjugular puncture of the portal vein. The puncture was done directly from the inferior vena cava in 5 cases and from the right liver vein in 11 cases. The puncture tract was dilated and subsequently supported by a Strecker stent. The stented shunt was patent in all cases immediately after the stent placement, but was obstructed by fibrous tissue in 7 of 8 cases reexamined by angiography and autopsy after 4 weeks. Complications seem to be related to the choice of the puncture site, with fewer complications when the puncture was done via the right hepatic vein.


Gut ◽  
1999 ◽  
Vol 44 (5) ◽  
pp. 739-742 ◽  
Author(s):  
L Spahr ◽  
J-P Villeneuve ◽  
M-P Dufresne ◽  
D Tassé ◽  
B Bui ◽  
...  

BACKGROUNDPortal hypertensive gastropathy and gastric antral vascular ectasia (GAVE) are increasingly recognised as separate entities. The pathogenic role of portal hypertension for the development of GAVE is still controversial.AIMSTo evaluate the effects of portal decompression on chronic bleeding related to GAVE in cirrhotic patients.METHODSEight patients with cirrhosis and chronic blood loss related to GAVE were included. GAVE was defined endoscopically and histologically.RESULTSAll patients had severe portal hypertension (mean portocaval gradient (PCG) 26 mm Hg) and chronic low grade bleeding. Seven patients underwent transjugular intrahepatic portosystemic shunt (TIPS) and one had an end to side portacaval shunt. Rebleeding occurred in seven patients. In these, TIPS was found to be occluded after 15 days in one patient; in the other six, the shunt was patent and the PCG was below 12 mm Hg in five. In the responder, PCG was 16 mm Hg. Antrectomy was performed in four non-responders; surgery was uneventful, and they did not rebleed after surgery, but two died 11 and 30 days postoperatively from multiorgan failure. In one patient, TIPS did not control GAVE related bleeding despite a notable decrease in PCG. This patient underwent liver transplantation 14 months after TIPS; two months after transplantation, bleeding had stopped and the endoscopic appearance of the antrum had normalised.CONCLUSIONSResults suggest that GAVE is not directly related to portal hypertension, but is influenced by the presence of liver dysfunction. Antrectomy is a therapeutic option when chronic bleeding becomes a significant problem but carries a risk of postoperative mortality.


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