scholarly journals Assessment of intrahepatic blood flow by Doppler ultrasonography: Relationship between the hepatic vein, portal vein, hepatic artery and portal pressure measured intraoperatively in patients with portal hypertension

2011 ◽  
Vol 11 (1) ◽  
Author(s):  
Li Zhang ◽  
Jikai Yin ◽  
Yunyou Duan ◽  
Yilin Yang ◽  
Lijun Yuan ◽  
...  
Keyword(s):  
Blood Flow ◽  
Portal Hypertension ◽  
Portal Vein ◽  
Hepatic Artery ◽  
Hepatic Vein ◽  
Doppler Ultrasonography ◽  
Portal Pressure

Splanchnic blood flow in the monkey during hemorrhagic shock

1965 ◽  
Vol 208 (2) ◽  
pp. 265-269 ◽  
Author(s):  
Francis L. Abel ◽  
John A. Waldhausen ◽  
Ewald E. Selkurt
Keyword(s):  
Blood Flow ◽  
Arterial Pressure ◽  
Portal Vein ◽  
Hemorrhagic Shock ◽  
Hepatic Vein ◽  
Venous Pressure ◽  
Portal Pressure ◽  
Mesenteric Arteries ◽  
Splanchnic Blood Flow

Blood flow in the celiac and superior mesenteric arteries was measured in nine Macaca monkeys during a standardized hemorrhagic shock procedure. Simultaneous pressures were obtained from the hepatic vein, portal vein, and aorta. Each animal was bled rapidly to an arterial pressure of 40 mm Hg and maintained at this level until 30% of the bled volume had spontaneously reinfused. The remaining blood was then rapidly reinfused and the animal observed until death. The results show a lack of overshoot of venous pressure on reinfusion, grossly pale intestines with some microscopic congestive changes, and a decrease in splanchnic conductance throughout the postinfusion period. Hepatic venous pressure exceeded portal pressure in six of the nine animals during the period of hemorrhage. The results are interpreted as indicative of insignificant splanchnic pooling during hemorrhagic shock in this animal.

scholarly journals Duplex Sonographic Evaluation of Hepatic Vasculature in Cirrhosis

2013 ◽  
Vol 2 (1) ◽  
pp. 13-19 ◽  
Author(s):  
K Ahmad ◽  
SK Khanna ◽  
A Sundas ◽  
RK Rauniyar ◽  
R Koirala ◽  
...  
Keyword(s):  
Blood Flow ◽  
Portal Hypertension ◽  
Hepatic Artery ◽  
Hepatic Vein ◽  
Morphological Changes ◽  
Resistive Index ◽  
Venous Blood Flow ◽  
Flow Profile ◽  
Coronary Veins ◽  
Hepatic Vasculature

Background: Cirrhosis of liver in an ancient illness, known to the mankind since antiquity. Alcohol consumption is the most important cause of micronodular cirrhosis and chronic hepatitis is the most frequent cause of macronodular cirrhosis. The objective of this study was to assess the morphological changes and flow haemodynamics in portal vein, hepatic vein and hepatic artery using various Doppler parameters. Methods: The study was done on prospective basis in 35 patients with clinical diagnosis of cirrhosis and these patients were subjected to ultrasonography of the abdomen for the assessment of morphological changes and flow haemodynamics in hepatic vasculature. Results: Portal venous blood flow becomes reversed with advanced portal hypertension, veno-occlusive disease and portosystemic shunts. Reduced portal blood flow velocity was observed in majority of the patients and was found to be lower in patients with history of variceal haemorrhage. Hepatic artery resistive index was found to be significantly higher in patients with dilated coronary veins as compared to those with normal non-dilated veins. Dilated paraumbilical vein was the most consistently observed collateral followed by dilated coronary veins. Abnormal hepatic vein flow profiles are seen in patients with cirrhosis, with decreased amplitude of phasic occilation pattern being the most frequently observed abnormality. Conclusion: Although many factors may affect the accuracy of volume flow and velocity measurements and the flow profile of the liver vasculature may change in different situations, Doppler ultrasound is useful in the assessment of the patient with cirrhosis and portal hypertension. Nepal Journal of Medical Sciences | Volume 02 | Number 01 | Jan-Jun 2013 | Page 13-19 DOI: http://dx.doi.org/10.3126/njms.v2i1.7645

Evolution of portal hypertension and mechanisms involved in its maintenance in a rat model

1985 ◽  
Vol 248 (6) ◽  
pp. G618-G625 ◽  
Author(s):  
E. Sikuler ◽  
D. Kravetz ◽  
R. J. Groszmann
Keyword(s):  
Blood Flow ◽  
Portal Hypertension ◽  
Portal Vein ◽  
Rat Model ◽  
Portal Pressure ◽  
Portal System ◽  
Hypertensive Rats ◽  
Hemodynamic Changes ◽  
Sequence Of Events ◽  
Radioactive Microsphere

In rats with portal hypertension induced by partial ligation of the portal vein, we have recently demonstrated an increased portal venous inflow that becomes an important factor in the maintenance of portal hypertension. The sequence of events that leads into this circulatory disarray is unknown. We evaluated chronologically the chain of hemodynamic changes that occurred after portal hypertension was induced by partial ligation of the portal vein. In this model it is possible to follow, from the initiation of the portal-hypertensive state, the interaction between blood flow and resistance in the portal system as well as the relation between the development of portal-systemic shunting and the elevated portal venous inflow. The study was performed in 45 portal-hypertensive rats and in 29 sham-operated rats. Blood flow and portal-systemic shunting were measured by radioactive microsphere techniques. The constriction of the portal vein was immediately followed by a resistance-induced portal hypertension characterized by increased portal resistance (9.78 +/- 0.89 vs. 4.18 +/- 0.71 dyn X s X cm-5 X 10(4), mean +/- SE, P less than 0.01), increased portal pressure (17.7 +/- 0.9 vs. 9.5 +/- 0.6 mmHg, P less than 0.001), and decreased portal venous inflow (3.93 +/- 0.26 vs. 6.82 +/- 0.49 ml X min-1 X 100 g body wt-1, P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals Evaluation of portal pressure by doppler ultrasound in patients with cirrhosis before and after simvastatin administration – a randomized controlled trial

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 256 ◽  
Author(s):  
Nadia Elwan ◽  
Raafat Salah ◽  
Manal Hamisa ◽  
Ebtsam Shady ◽  
Nehad Hawash ◽  
...  
Keyword(s):  
Blood Flow ◽  
Portal Hypertension ◽  
Portal Vein ◽  
Hepatic Artery ◽  
Doppler Ultrasound ◽  
Resistance Index ◽  
Control Group ◽  
Randomized Controlled ◽  
Group I ◽  
Before And After

Background: Portal hypertension is one of the most frequent complications of cirrhosis. β-adrenergic blockers, with or without organic nitrates, are currently used as hypotensive agents. Statins such as simvastatin seem to be safe for patients with chronic liver diseases and exert multiple pleiotropic actions. This study aimed to assess PTH using Doppler ultrasound in patients with cirrhosis before and after simvastatin administration. Methods: This randomized controlled clinical trial was conducted on 40 patients with cirrhosis who were randomized into 2 groups: group I included 20 patients with cirrhosis who were administered 20 mg of simvastatin daily for 2 weeks and then 40 mg daily for another 2 weeks, and group II included 20 patients with cirrhosis who did not receive simvastatin as a control group. All patients underwent full clinical examination, laboratory investigations, and abdominal Doppler ultrasound at baseline and after 30 days to evaluate portal vein diameter, blood flow volume, direction and velocity of portal vein blood flow, hepatic artery resistance and pulsatility indices, splenic artery resistance index, portal hypertension index (PHI), liver vascular index, and modified liver vascular index (MLVI). Results: There was a highly significant decrease in the hepatic artery resistance index  in group I, from 0.785 ± 0.088 to 0.717 ± 0.086 (P < 0.001). There was a significant decrease in the PHI in group I , from 3.915 ± 0.973 m/sec to 3.605 ± 1.168 m/sec (P = 0.024). Additionally, there was a significant increase in the MLVI in group I from 11.540 ± 3.266 cm/sec to 13.305 ± 3.222 cm/sec, an increase of 15.3% from baseline (P = 0.009). No significant adverse effects were detected. Conclusions: Simvastatin is safe and effective in lowering portal hypertension. [ClinicalTrials.gov Identifier: NCT02994485]

scholarly journals Duplex doppler sonography in portal hypertension

2007 ◽  
Vol 60 (3-4) ◽  
pp. 161-167 ◽  
Author(s):  
Dijana Niciforovic ◽  
Viktor Till ◽  
Dusan Hadnadjev ◽  
Mira Govorcin ◽  
Zorka Lucic ◽  
...  
Keyword(s):  
Blood Flow ◽  
Portal Hypertension ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Doppler Ultrasonography ◽  
Doppler Sonography ◽  
Imaging Modality ◽  
Vein Thrombosis ◽  
Duplex Doppler ◽  
Duplex Doppler Sonography

Conventional echotomography and duplex Doppler ultrasonography are noninvasive imaging techniques in measurement of hepatic blood flow. In the period from February 2002 to March 2004, 29.086 patients underwent ultrasound examination at the Institute of Radiology in Novi Sad, and 17.503 presented with symptoms of gastroenterology diseases and/or hepatobiliary tract diseases. 984 patients underwent duplex Doppler sonography. This prospective study included 50 patients with suspected or confirmed diagnosis of portal hypertension. All patients were examined using Siemens Versa Pro (3.5 MHz convex probe; B-mode, color and pulse Doppler). The following parameters were evaluated: Doppler sonoscore, congestion index and portal vein thrombosis. By analyzing gathered data, the diagnosis of portal hypertension was confirmed in 10% of patients at baseline, and in 6% of patients at last follow-up, six months later. Results of this investigation demonstrate the importance of duplex Doppler ultrasonography as an excellent noninvasive diagnostic method used for visualization of the direction and velocity of blood flow, as well as presence of portal vein thrombosis. This imaging modality is used as an initial diagnostic tool in the evaluation of the portohepatic circulation, especially in portal hypertension syndrome and in suspected portal vein thrombosis. .

Role of humoral factors in the intestinal hyperemia associated with chronic portal hypertension

1984 ◽  
Vol 247 (5) ◽  
pp. G486-G493 ◽  
Author(s):  
J. N. Benoit ◽  
J. A. Barrowman ◽  
S. L. Harper ◽  
P. R. Kvietys ◽  
D. N. Granger
Keyword(s):  
Blood Flow ◽  
Portal Hypertension ◽  
Portal Vein ◽  
Vascular Resistance ◽  
Portal Pressure ◽  
Systemic Arterial Pressure ◽  
Hypertensive Rats ◽  
Humoral Factors ◽  
Arterial Blood

The role of neural, metabolic, physical, and humoral factors in the intestinal hyperemia associated with chronic portal hypertension was examined by use of the rat portal vein stenosis model. Intestinal blood flow and splenic pulp pressure were increased, while systemic arterial pressure and total vascular resistance were reduced in portal vein-stenosed rats as compared with controls. The reduction in total vascular resistance was entirely due to a fall in precapillary resistance and was accompanied by an increase in intestinal capillary pressure, which exceeded that produced by acute portal pressure elevation to the same level. Arteriovenous shunting of 15-micron microspheres was four times higher in portal-hypertensive rats. Cross-perfusion of control intestinal preparations with arterial blood from portal-hypertensive rats produced a 30% increase in blood flow. Plasma glucagon levels in portal-hypertensive rats were three times higher than in controls. Intra-arterial infusion of glucagon (at a rate that achieved the concentration measured in portal-hypertensive animals) produced a 20% reduction in intestinal vascular resistance. The results of these studies indicate that humoral factors, including glucagon, are primarily responsible for the hyperemia associated with portal hypertension.

scholarly journals Multidisciplinary treatment of left hepatic artery pseudoaneurysm after hepatobiliary resection for gallbladder cancer: a case report

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Ryusei Yamamoto ◽  
Teiichi Sugiura ◽  
Yukiyasu Okamura ◽  
Takaaki Ito ◽  
Yusuke Yamamoto ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Liver Failure ◽  
Hepatic Artery ◽  
Remnant Liver ◽  
Left Hepatic Artery ◽  
Artery Pseudoaneurysm ◽  
Hepatobiliary Resection ◽  
Portal Vein Arterialization ◽  
Arterial Inflow

Abstract Background When a postoperative hepatic artery pseudoaneurysm develops after massive hepatectomy, both an intervention for the pseudoaneurysm and patency of hepatic artery should be considered because occlusion of the residual hepatic artery results in critical liver failure. However, the treatment strategy for a pseudoaneurysm of the hepatic artery after hepatobiliary resection is not well established. Case presentation A 65-year-old woman underwent right hepatectomy, extrahepatic duct resection, and portal vein resection, for gallbladder cancer. Although the patient had an uneventful postoperative course, computed tomography on postoperative day 6 showed a 6-mm pseudoaneurysm of the hepatic artery. Angiography revealed the pseudoaneurysm located on the bifurcation of the left hepatic artery to the segment 2 artery plus the segment 3 artery and 4 artery. Stent placement in the left hepatic artery was not feasible because the artery was too narrow, and coiling of the pseudoaneurysm was associated with a risk of occluding the left hepatic artery and inducing critical liver failure. Therefore, portal vein arterialization constructed by anastomosing the ileocecal artery and vein was performed prior to embolization of the pseudoaneurysm to maintain the oxygen level of the remnant liver, even if the left hepatic artery was accidentally occluded. The pseudoaneurysm was selectively embolized without occlusion of the left hepatic artery, and the postoperative laboratory data were within normal limits. Although uncontrollable ascites due to portal hypertension occurred, embolization of the ileocolic shunt rapidly resolved it. The patient was discharged on postoperative day 45. Conclusion Portal vein arterialization prior to embolization of the aneurysm may be a feasible therapeutic strategy for a pseudoaneurysm that develops after hepatectomy for hepatobiliary malignancy to guarantee arterial inflow to the remnant liver. Early embolization of arterioportal shunting after confirmation of arterial inflow to the liver should be performed to prevent morbidity induced by portal hypertension.

scholarly journals Correction of extrahepatic portal hypertension in pediatric patient after liver transplantation

2017 ◽  
Vol 19 (1) ◽  
pp. 47-51
Author(s):  
A. R. Monakhov ◽  
B. L. Mironkov ◽  
T. A. Dzhanbekov ◽  
K. O. Semash ◽  
Kh. M. Khizroev ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Blood Flow ◽  
Portal Hypertension ◽  
Portal Vein ◽  
Pediatric Patient ◽  
Portal Blood Flow ◽  
Portal Blood ◽  
Positive Trend ◽  
Portal Vein Stenosis ◽  
Vein Stenosis

Introduction. Liver transplantation is a multi-component and complex type of operative treatment. Patients undergoing such a treatment sometimes are getting various complications. One of these complications is a portal hypertension associated with portal vein stenosis.Materials and methods. In 6 years after the left lateral section transplantation from living donor in a pediatric patient the signs of portal hypertension were observed. Stenosis of the portal vein was revealed. Due to this fact percutaneous transhepatic correction of portal vein stenosis was performed.Results. As a result of the correction of portal blood flow in the patient a positive trend was noted. According to the laboratory and instrumental methods of examination the graft had a normal function, portal blood flow was adequate. In order to control the stent patency Doppler ultrasound and MSCT of the abdominal cavity with intravenous bolus contrasting were performed. Due to these examinations the stent function was good, the rate of blood flow in the portal vein due to Doppler data has reached 80 cm/sec, and a decrease of the spleen size was noted.Conclusion. Diagnosis and timely detection of portal vein stenosis in patients after liver transplantation are very important for the preservation of graft function and for the prevention of portal hypertension. In order to do that, ultrasound Doppler fluorimetry examination needs to be performed to each patient after liver transplantation. In cases of violation of the blood flow in the portal vein CT angiography performance is needed. Percutaneous transhepatic stenting of portal vein is a minimally invasive and highly effective method of correction of portal hypertension. Antiplatelet therapy and platelet aggregation control are the prerequisites for successful stent function.

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