scholarly journals Surgical Ligation of Extrahepatic Shunt under Guidance of Doppler Ultrasound, Portography, and Portal Pressure Monitoring

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Mitsugi Shimoda ◽  
Takayuki Shimizu ◽  
Keiichi Kubota
Keyword(s):  
Doppler Ultrasound ◽  
Portal Pressure ◽  
Vena Cava ◽  
Flow Speed ◽  
Portosystemic Shunt ◽  
Portal System ◽  
Pressure Monitoring ◽  
Portal Flow ◽  
Surgical Ligation ◽  
Disturbance Of Consciousness

A 54-year-old man with chronic hepatitis C was admitted to our hospital because of a disturbance of consciousness and hyperammonemia. Abdominal angiography revealed a portosystemic shunt between the superior mesenteric vein and inferior vena cava. Endoscopic examination showed no varix. As interventional treatment was unsuccessful, surgical ligation of the shunt was performed. After surgery, portography revealed a huge shunt. Before ligation, the portal pressure, portal flow speed, and volume at the umbilical portion were 24 H2O. 5.6 cm/s and 203 ml/min, respectively. Finally the shunt was ligated. The portal flow speed and volume increased for 14 days following surgery and then stabilized. No varices were observed postoperatively. Doppler ultrasound, portography, and portal pressure monitoring can be used to reveal haemodynamic changes in the portal system and justify surgical ligation of portosystemic shunt.

scholarly journals Multistage closure of a congenital extrahepatic portosystemic shunt

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
João Facas ◽  
Manuel Cruz ◽  
João Filipe Costa ◽  
Alfredo Agostinho ◽  
Paulo Donato
Keyword(s):  
Atrial Septal Defect ◽  
Endovascular Treatment ◽  
Septal Defect ◽  
Portal Pressure ◽  
Vena Cava ◽  
Portosystemic Shunt ◽  
Short Length ◽  
Portal System ◽  
Level Of Evidence ◽  
Portosystemic Shunts

Abstract Background Congenital extrahepatic portosystemic shunts (CEPS) are rare shunts connecting the extrahepatic portal system with the inferior vena cava. Shunt dimensions and the risk of portal hypertension determines the closure strategy. Endovascular treatment is indicated for single stage occlusion of longer length shunts, whereas the remaining shunt types are preferentially surgically occluded. Herein we describe the technical details of a novel endovascular treatment for short length CEPS. Case presentation A 15-years-old male with a short length CEPS complicated with multinodular liver disease was submitted to a multistage closure, as indicated by the high portal pressure values during shunt balloon occlusion venography. Initially a transjugular intrahepatic portosystemic shunt (TIPS) was created and the CEPS occluded with an atrial septal defect occluder. In a second procedure the TIPS was embolized with a flow reductor stent and an amplatzer vascular plug II. At a 1 year follow up the liver nodules size reduced, the patient remains asymptomatic, and the shunt adequately closed. Conclusion This paper outlines the potential use of a TIPS and an atrial septal defect occluder combination in complex CEPS, supporting its usage as an alternative to the standard surgical treatment. Level of Evidence: Level 4, Case report.

Successful Surgical Ligation Under Intraoperative Portal Vein Pressure Monitoring of a Large Portosystemic Shunt Presenting as an Intrapulmonary Shunt: Report of a Case

Surgery Today ◽  
2004 ◽  
Vol 34 (12) ◽  
pp. 1049-1052 ◽  
Author(s):  
Hiroshi Yagi ◽  
Yasutsugu Takada ◽  
Yasuhiro Fujimoto ◽  
Yasuhiro Ogura ◽  
Koichi Kozaki ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portosystemic Shunt ◽  
Pressure Monitoring ◽  
Intrapulmonary Shunt ◽  
Portal Vein Pressure ◽  
Surgical Ligation

scholarly journals Characterization of the Normal Portal and Hepatic Blood Flow of Adult Holstein-Friesian Cows

Animals ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. 386 ◽  
Author(s):  
J. Daniel Barreiro-Vázquez ◽  
Marta Miranda ◽  
M. Isabel Barreiro-Vilanova ◽  
F. Javier Diéguez ◽  
Andrés Barreiro-Lois
Keyword(s):  
Blood Flow ◽  
Doppler Ultrasound ◽  
Hepatic Blood Flow ◽  
Vena Cava ◽  
Flow Characteristics ◽  
Portal System ◽  
Holstein Friesian ◽  
Anatomical Point ◽  
Friesian Cows

In the past, hepatic blood flow in cows was invasively characterized to investigate different pathologies and physiological conditions. However, hepatic blood flow can be easily evaluated with transabdominal Doppler ultrasound. Sixteen healthy adult non-lactating, non-pregnant Holstein-Friesian cows were examined using B-mode and Doppler ultrasound between the right flank and 9th intercostal space to establish the best approach to the different parts of the portal and hepatic vein systems, and determine normal blood flow characteristics. The main portal vein was characterized by a turbulent, high-velocity flow due to the opposing confluence of the splenic and cranial mesenteric veins, while hepatic and caudal vena cava veins have laminar blood flow, in which the phasicity is considered mainly respiratory in origin. Reference values were determined in relation to the anatomical point of observation. In conclusion, transabdominal Doppler ultrasound of the portal system is a simple technique that allows non-invasive characterization of portal and hepatic blood haemodynamics in cows.

scholarly journals Dopplervelocimetric evaluation of portal vein as a diagnostic tool for portosystemic shunt diagnosis in dogs

2009 ◽  
Vol 39 (5) ◽  
pp. 1433-1437 ◽  
Author(s):  
Cibele Figueira Carvalho ◽  
Giovanni Guido Cerri ◽  
Maria Cristina Chammas
Keyword(s):  
Portal Vein ◽  
Flow Velocity ◽  
Vena Cava ◽  
Portosystemic Shunt ◽  
Portal Flow ◽  
Liver Size ◽  
Hemodynamic Assessment ◽  
Duplex Doppler ◽  
Clinical Records ◽  
Tortuous Vessel

The objective of this research was to verify if the study of portal hemodynamic parameters through duplex Doppler ultrasonography (DUS) is able to help to detect portosystemic shunt (PSS) and the shunted vessel origin. It was detected PSS in 20 dogs by abdominal DUS and confirmed at surgery or necropsy from March of 2004 until March 2007. Main ultrasonographic findings were: identification of a tortuous vessel shunting portal flow being: portocaval shunt (16/20 or 80%), esplenocaval shunt (2/20 or 10%), gastrocaval shunt (1/20 or 5%), portoazigo shunt (1/20 or 5%); 2) elevated portal flow velocity before shunt (17/20 or 81%), 3) lower portal flow velocity after shunt (17/20 or 81%), 4) turbulence in the caudal vena cava (10/20 or 47,5%) and 5) reduced liver size (15/20 or 71%). The others ultrasonographic findings associated with clinical records were similar to that described in literature. With this work we could conclude that hemodynamic assessment of portal vein with DUS may be a useful tool for PSS diagnosis and to detect the shunted vessel origin.

scholarly journals Successful Reversal of Chronic Incapacitating Post-TIPS Encephalopathy by Balloon Occlusion of the Stent

1994 ◽  
Vol 8 (2) ◽  
pp. 75-80 ◽  
Author(s):  
Daphna Fenyves ◽  
Michel P Dufresne ◽  
Jean Raymond ◽  
Michel Lafortune ◽  
Bernard Willems ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Balloon Occlusion ◽  
Portosystemic Shunt ◽  
Portal System ◽  
Variceal Hemorrhage ◽  
General Anesthetic ◽  
Portal Flow ◽  
Life Threatening ◽  
Intrahepatic Portosystemic Shunt ◽  
A New Technique

Transjugular intrahepatic portosystemic shunt (TIPS) placement is a new technique allowing decompression of the portal system without the need for abdominal surgery or general anesthetic. This promising procedure appears safe, and is being evaluated in the context of life threatening uncontrollable variceal hemorrhage as well as ascites refractory to medical treatment. Following TIPS, portal flow diversion is associated with hepatic encephalopathy in up to 25% of patients. This is most often mild and treatable but may become uncontrollable, incapacitating and even life threatening in up to 3 to 5% of cases. The authors present two patients in whom such life threatening encephalopathy and stupor was reversed by transjugular balloon occlusion of the TIPS.

Risk Factors for Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt in Patients with Hepatocellular Carcinoma and Portal Hypertension

2015 ◽  
Vol 24 (3) ◽  
pp. 301-307 ◽  
Author(s):  
Jiannan Yao ◽  
Li Zuo ◽  
Guangyu An ◽  
Zhendong Yue ◽  
Hongwei Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Portal Hypertension ◽  
Hepatic Encephalopathy ◽  
Pressure Gradient ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Meld Score ◽  
Portosystemic Shunt ◽  
Portal Flow ◽  
Intrahepatic Portosystemic Shunt

Aims: This study aimed at assessing the risk factors for hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) in patients with hepatocellular carcinoma (HCC) and portal hypertension. Method: Consecutive patients (n=279) with primary HCC who underwent TIPS between January 1997 and March 2012 at a single institution were retrospectively reviewed. Patients were followed up for 2 years. Pre-TIPS, peri-TIPS and post-TIPS clinical variables were reviewed using univariate and multivariate analyses to identify risk factors for HE after TIPS. Results: The overall incidence of HE was 41% (114/279). Multivariate analysis showed an increased odds for HE in patients with: >3 treatments with transcatheter arterial chemoembolization (TACE) and/or trans-arterial embolization (TAE) (odds ratio [OR], 4.078; 95% confidence interval [95%CI], 1.748-9.515); hepatopetal portal flow (OR, 2.362; 95%CI, 1.032-5.404); high portosystemic pressure gradient (OR, 1.198; 95%CI, 1.073-1.336) and high pre-TIPS MELD score (OR, 1.693; 95%CI, 1.390-2.062). Odds for HE were increased 1.693 fold for each 1-point increase in the MELD score, and 1.198 fold for each 1-mmHg decrease in the post-TIPS portosystemic pressure gradient. Conclusion: The identification of clinical variables associated with increased odds of HE may be useful for the selection of appropriate candidates for TIPS. Results suggest that an inappropriate decrease in the portosystemic pressure gradient might be associated with HE after TIPS. In addition, >3 treatments with TACE/TAE, hepatopetal portal flow, and high MELD score were also associated with increased odds of HE after TIPS. Key words:  –  –  – .

Recanalization and Reconstruction of a Chronically Occluded Inferior Vena Cava Through an Existing Transjugular Intrahepatic Portosystemic Shunt in the Setting of Budd-Chiari Syndrome

2021 ◽  
pp. 153857442110020
Author(s):  
Reza Talaie ◽  
Hamed Jalaeian ◽  
Nassir Rostambeigi ◽  
Anthony Spano ◽  
Jafar Golzarian
Keyword(s):  
Inferior Vena Cava ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Inferior Vena ◽  
Vena Cava ◽  
Portosystemic Shunt ◽  
Hepatic Veins ◽  
Budd Chiari Syndrome ◽  
Chiari Syndrome ◽  
Intrahepatic Portosystemic Shunt ◽  
The Right

Budd-Chiari syndrome (BCS) results from the occlusion or flow reduction in the hepatic veins or inferior vena cava and can be treated with transjugular intrahepatic portosystemic shunt when hepatic vein recanalization fails.1-3 Hypercoagulable patients with primary BCS are predisposed to development of new areas of thrombosis within the TIPS shunt or IVC. This case details a patient with BCS, pre-existing TIPS extending to the right atrium, and chronic retrohepatic IVC thrombosis who underwent sharp recanalization of the IVC with stenting into the TIPS stent bridging the patient until his subsequent hepatic transplantation.

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