Left-sided portal hypertension after pancreaticoduodenectomy with resection of superior mesenteric-portal vein confluence: Efficacy of concomitant splenic artery resection

The results a new approach of simultaneous correction of complications of portal hypertension with endovideosurgical method are considered. Surgeries of 4 patients, suffering from portal hypertension, were performed by laparoscopic access and included gastric devascularization with ligation and the transection of the left gastric and short gastric veins; ligation of the splenic artery; resection of the parietal peritoneum, retroperitoneal tissue, and lumbar muscles in the lumbar triangle. Average duration of one surgery was 120±22 minutes. The highest volume of blood loss was 150±35 ml. There were no intraoperative complications. The average time spent in the IC unit was 14±4,2 hours. On the day following the surgery, all patients were able to get out of the bed, walked on their own and were allowed to have liquid food. Each patient had one session of endoscopic ligation with an overlay of 5 to 8 Cook ligatures to eradicate varicose veins of the esophagus. The postoperative period of hospital treatment was 10±2,3 days, treatment responses were favorable in all patients. The total time of inpatient stay was 22±3 days. All patients underwent two sessions of reinfusion of externally modified ascitic fluid. The postoperative spiral computer tomographies and subtraction digital angiographies showed effectiveness of disconnection of vessels in the gastroesophageal system. Blood flow in the splenic artery is not detected, ultrasound shows shrinkage of spleen. The maximum follow-up after the operation was 10 months. There were no episodes of bleeding recurrence and no signs of ascites. All patients are socially adapted and able to work, and do not present any complaints during follow-up examinations.

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Hypersplenism in a young girl: managed non-surgically

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20173598 ◽

2017 ◽

Vol 5 (8) ◽

pp. 3742

Author(s):

Tanvi Batra ◽

Shipra Gulati ◽

Vijayashree S. Gokhale ◽

Arjun Lal Kakrani

Keyword(s):

Portal Hypertension ◽

Portal Vein ◽

Splenic Artery ◽

Gastric Varices ◽

Splenic Infarction ◽

Artery Embolization ◽

Splenic Artery Embolization ◽

Post Procedure ◽

Left Hypochondrium ◽

Grade Iii

A 16-years-old female, non-alcoholic, presented with pain in left hypochondrium and distention of abdomen. Her USG Abdomen, portal vein doppler and CT abdomen revealed chronic thrombosis of intrahepatic portion of portal vein with multiple collaterals and gross splenomegaly suggestive of portal hypertension. Trans jugular liver biopsy showed no regeneration or fibrosis of liver. Endoscopy showed grade III oesophageal and gastric varices. Splenic artery embolisation was done for hypersplenism. Post procedure CT abdomen revealed large areas of splenic infarction-sequelae of splenic artery embolization.

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Stability of a rat model of prehepatic portal hypertension caused by partial ligation of the portal vein

World Journal of Gastroenterology ◽

10.3748/wjg.15.3449 ◽

2009 ◽

Vol 15 (32) ◽

pp. 3449

Author(s):

Zhe Wen ◽

Jin-Zhe Zhang ◽

Hui-Min Xia ◽

Chun-Xiao Yang ◽

Ya-Jun Chen

Keyword(s):

Portal Hypertension ◽

Portal Vein ◽

Rat Model

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Vascular Involvements in Cholangiocarcinoma: Tips and Tricks

Cancers ◽

10.3390/cancers13153735 ◽

2021 ◽

Vol 13 (15) ◽

pp. 3735

Author(s):

Roberta Angelico ◽

Bruno Sensi ◽

Alessandro Parente ◽

Leandro Siragusa ◽

Carlo Gazia ◽

...

Keyword(s):

Portal Vein ◽

Hepatic Artery ◽

Vena Cava ◽

High Volume ◽

Vascular Reconstruction ◽

Ex Situ ◽

Vascular Involvement ◽

Hepatic Veins ◽

Hepatic Artery Resection ◽

Artery Resection

Cholangiocarcinoma (CCA) is an aggressive malignancy of the biliary tract. To date, surgical treatment remains the only hope for definitive cure of CCA patients. Involvement of major vascular structures was traditionally considered a contraindication for resection. Nowadays, selected cases of CCA with vascular involvement can be successfully approached. Intrahepatic CCA often involves the major hepatic veins or the inferior vena cava and might necessitate complete vascular exclusion, in situ hypothermic perfusion, ex situ surgery and reconstruction with autologous, heterologous or synthetic grafts. Hilar CCA more frequently involves the portal vein and hepatic artery. Resection and reconstruction of the portal vein is now considered a relatively safe and beneficial technique, and it is accepted as a standard option either with direct anastomosis or jump grafts. However, hepatic artery resection remains controversial; despite accumulating positive reports, the procedure remains technically challenging with increased rates of morbidity. When arterial reconstruction is not possible, arterio-portal shunting may offer salvage, while sometimes an efficient collateral system could bypass the need for arterial reconstructions. Keys to achieve success are represented by accurate selection of patients in high-volume referral centres, adequate technical skills and eclectic knowledge of the various possibilities for vascular reconstruction.

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Stent patency and outcome of TIPS through the left versus the right portal branches

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00305-z ◽

2020 ◽

Vol 51 (1) ◽

Author(s):

Mohamed S. Alwarraky ◽

Hasan A. Elzohary ◽

Mohamed A. Melegy ◽

Anwar Mohamed

Keyword(s):

Portal Hypertension ◽

Clinical Outcome ◽

Portal Vein ◽

Variceal Bleeding ◽

Patency Rate ◽

Hospital Admissions ◽

Stent Patency ◽

Left Branch ◽

The Right

Abstract Background Our purpose is to compare the stent patency and clinical outcome of trans-jugular intra-hepatic porto-systemic shunt (TIPS) through the left branch portal vein (TIPS-LPV) to the standard TIPS through the right branch (TIPS-RPV). We retrospectively reviewed all patients (n = 54) with refractory portal hypertension who were subjected to TIPS-LPV at our institute (TIPS-LPV) between 2016 and 2018. These patients were matched with 56 control patients treated with the standard TIPS-RPV (TIPS-RPV). The 2 groups were compared regarding the stent patency rate, encephalopathy, and re-interventions for 1 year after the procedure. Results TIPS-LPV group showed 12 months higher patency rate (90.7% compared to 73.2%) (P < 0.005). The number of the encephalopathy attacks in the TIPS-LPV group was significantly lower than that of the TIPS-RPV group at 6 and 12 months of follow-up [P = 0.012 and 0.036, respectively]. Re-bleeding and improvement of ascites were the same in the two groups [P > 0.05]. Patients underwent TIPS-LPV needed less re-interventions and required less hospitalizations than those with TIPS-RPV [P = 0.039 and P = 0.03, respectively]. Conclusion The new TIPS approach is to extend the stent to LPV. This new TIPS-LPV approach showed the same clinical efficiency as the standard TIPS-RPV in treating variceal bleeding and ascites. However, it proved a better stent patency with lower rates of re-interventions, encephalopathy, and hospital admissions than TIPS through the right branch.

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Splenic Artery Embolisation for the Emergency Treatment of Sinistral Portal Hypertension: A Systematic Review

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0041-1730876 ◽

2021 ◽

Vol 5 (02) ◽

pp. 079-085

Author(s):

Harriet Grout-Smith ◽

Ozbil Dumenci ◽

N. Paul Tait ◽

Ali Alsafi

Keyword(s):

Systematic Review ◽

Portal Hypertension ◽

Variceal Bleeding ◽

Splenic Artery ◽

Splenic Vein ◽

Treatment Modalities ◽

Portal System ◽

Technical Success Rate ◽

Randomized Controlled Studies ◽

Sinistral Portal Hypertension

Abstract Objectives Sinistral portal hypertension (SPH) is caused by increased pressure on the left portal system secondary to splenic vein stenosis or occlusion and may lead to gastric varices. The definitive management of SPH is splenectomy, but this is associated with significant mortality and morbidity in the acute setting. In this systematic review, we investigated the efficacy and safety of splenic artery embolisation (SAE) in managing refractory variceal bleeding in patients with SPH. Methods A comprehensive literature search was conducted using MEDLINE and Embase databases. A qualitative analysis was chosen due to heterogeneity of the studies. Results Our search yielded 339 articles, 278 of which were unique. After initial screening, 16 articles relevant to our search remained for full text review. Of these, 7 were included in the systematic review. All 7 papers were observational, 6 were retrospective. Between them they described 29 SAE procedures to control variceal bleeding. The technical success rate was 100% and there were no cases of rebleeding during follow up. The most common complication was post-embolisation syndrome. Four major complications occurred, two resulting in death. These deaths were the only 30-day mortalities recorded and were in patients with extensive comorbidities. Conclusions Although there is a distinct lack of randomized controlled studies comparing SAE to other treatment modalities, it appears to be safe and effective in treating hemorrhage secondary to SPH.

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A comparative study of multi-detector CT portography versus endoscopy in evaluation of gastro-esophageal varices in portal hypertension patients

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-019-0117-5 ◽

2020 ◽

Vol 51 (1) ◽

Author(s):

Hany El-Assaly ◽

Lamiaa I. A. Metwally ◽

Heba Azzam ◽

Mohamed Ibrahim Seif-Elnasr

Keyword(s):

Portal Hypertension ◽

Portal Vein ◽

Esophageal Varices ◽

Imaging Modality ◽

Splenic Vein ◽

Gastric Varices ◽

Gi Endoscopy ◽

Upper Gi ◽

Upper Gi Endoscopy ◽

Vein Diameter

Abstract Background Portal hypertension is a major complication resulting from obstruction of portal blood flow, like cirrhosis or portal vein thrombosis, that leads to portal hypertension. MDCT angiography has become an important tool for investigation of the liver as well as potentially challenging varices by detailing the course of these tortuous vessels. This information is decisive for liver transplantation as well as for common procedures in which an unexpected varix can cause significant bleeding. Results This study included an assessment of 60 cases of portal hypertension (28 males and 32 females), their age ranged from 42 to 69 years (mean age = 57.2 ± 6.63). All patients were diagnosed with portal hypertension, underwent upper GI endoscopy followed by a triphasic CT scan with CT angiographic assessment for the screening of gastro-esophageal varices. CT is highly sensitive as compared to upper GI endoscopy (sensitivity 93%) in detecting esophageal varices. Gastric varices detected by CT in 22 patients (37%) compared to 14 patients (23%) detected by endoscopy. While paraesophageal varices were detected in 63% of patients and retro-gastric varices in 80% of patients that were not visualized by endoscopy. Our study reported that the commonest type of collaterals were the splenic collaterals, and we also found there is a significant correlation between the portal vein diameter and the number of collaterals as well as between the portal vein diameter and splenic vein diameter. Conclusions Multi-slice CT serves as an important non-invasive imaging modality in the diagnosis of collaterals in cases of portal hypertension. CT portography can replace endoscopy in the detection of high-risk varices. It also proved that there is a correlation between portal vein diameter, splenic vein diameter, and number of collaterals.

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P225 Partial splenic artery embolisation for portal hypertension – a single centre experience

10.1136/gutjnl-2020-bsgcampus.300 ◽

2021 ◽

Author(s):

Jie Han Yeo ◽

Brian Hogan ◽

Nigel Heaton ◽

Vishal Patel ◽

Mark McPhail ◽

...

Keyword(s):

Portal Hypertension ◽

Splenic Artery ◽

Single Centre ◽

Single Centre Experience

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