Visualization of the portal vein via the vertebral venous plexus in a patient without vena cava obstruction.

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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5-HT causes splanchnic venodilation

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00165.2017 ◽

2017 ◽

Vol 313 (3) ◽

pp. H676-H686 ◽

Cited By ~ 12

Author(s):

Bridget M. Seitz ◽

Hakan S. Orer ◽

Teresa Krieger-Burke ◽

Emma S. Darios ◽

Janice M. Thompson ◽

...

Keyword(s):

Blood Pressure ◽

Inferior Vena Cava ◽

Portal Vein ◽

Superior Mesenteric Vein ◽

Inferior Vena ◽

Vena Cava ◽

Receptor Protein ◽

Mesenteric Vein

Serotonin [5-hydroxytryptamine (5-HT)] causes relaxation of the isolated superior mesenteric vein, a splanchnic blood vessel, through activation of the 5-HT7 receptor. As part of studies designed to identify the mechanism(s) through which chronic (≥24 h) infusion of 5-HT lowers blood pressure, we tested the hypothesis that 5-HT causes in vitro and in vivo splanchnic venodilation that is 5-HT7 receptor dependent. In tissue baths for measurement of isometric contraction, the portal vein and abdominal inferior vena cava relaxed to 5-HT and the 5-HT1/7 receptor agonist 5-carboxamidotryptamine; relaxation was abolished by the 5-HT7 receptor antagonist SB-269970. Western blot analyses showed that the abdominal inferior vena cava and portal vein express 5-HT7 receptor protein. In contrast, the thoracic vena cava, outside the splanchnic circulation, did not relax to serotonergic agonists and exhibited minimal expression of the 5-HT7 receptor. Male Sprague-Dawley rats with chronically implanted radiotelemetry transmitters underwent repeated ultrasound imaging of abdominal vessels. After baseline imaging, minipumps containing vehicle (saline) or 5-HT (25 μg·kg−1·min−1) were implanted. Twenty-four hours later, venous diameters were increased in rats with 5-HT-infusion (percent increase from baseline: superior mesenteric vein, 17.5 ± 1.9; portal vein, 17.7 ± 1.8; and abdominal inferior vena cava, 46.9 ± 8.0) while arterial pressure was decreased (~13 mmHg). Measures returned to baseline after infusion termination. In a separate group of animals, treatment with SB-269970 (3 mg/kg iv) prevented the splanchnic venodilation and fall in blood pressure during 24 h of 5-HT infusion. Thus, 5-HT causes 5-HT7 receptor-dependent splanchnic venous dilation associated with a fall in blood pressure. NEW & NOTEWORTHY This research is noteworthy because it combines and links, through the 5-HT7 receptor, an in vitro observation (venorelaxation) with in vivo events (venodilation and fall in blood pressure). This supports the idea that splanchnic venodilation plays a role in blood pressure regulation.

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Hepatic encephalopathy due to a large intrahepatic communication between the portal vein and inferior vena cava

Journal of Gastroenterology and Hepatology ◽

10.1111/j.1440-1746.1990.tb01133.x ◽

1990 ◽

Vol 5 (6) ◽

pp. 718-721

Author(s):

SHOZO IWAMOTO ◽

KUNIO OKUDA

Keyword(s):

Hepatic Encephalopathy ◽

Inferior Vena Cava ◽

Portal Vein ◽

Inferior Vena ◽

Vena Cava

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Tumoural portal vein thrombosis

Acta Radiologica ◽

10.1080/02841859709172397 ◽

1997 ◽

Vol 38 (5) ◽

pp. 655-659

Author(s):

L. Marti-Bonmati ◽

E. Lonjedo ◽

D. Mathieu ◽

C. Coffin ◽

C. Poyatos ◽

...

Keyword(s):

Mr Imaging ◽

Portal Vein ◽

Imaging Techniques ◽

Vena Cava ◽

Tumour Thrombus ◽

Vein Thrombosis ◽

Significant Difference ◽

Before And After ◽

Portal Veins ◽

Cellular Carcinoma

Purpose: Intrahepatic thrombus is usually associated with either cirrhosis or hepato-cellular carcinoma (HCC). Most HCCs enhance after the administration of MnDPDP (Teslascan). Our objective was to analyze the enhancement characteristics of tumour portal vein thrombi. Material and Methods: Thrombi affecting the main or segmental portal veins (17 cases) and the suprahepatic inferior vena cava (1 case) were retrospectively selected from a series of 128 patients studied with MR imaging before and after the administration of MnDPDP. Enhancement was assessed qualitatively and quantitatively. Results: All tumour thrombi enhanced after MnDPDP administration. The enhancement was more conspicuous in the GRE images. On the quantitative evaluation, the portal thrombus enhancement was greater for GRE images than SE images. Portal thrombi enhanced more than the liver and the HCCs. There was a significant difference between the enhancement of the HCCs and the thrombi with both MR imaging techniques. Conclusion: The greater enhancement of the tumour thrombus associated with the liver and HCC may suggest that other mechanisms, apart from accumulation of the contrast medium within the hepatocytes inside the thrombi, are involved in thrombus enhancement.

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ABERNETHY MALFORMATION AS A RARE INDICATION FOR LIVER TRANSPLANTATION: CASE REPORT

Liječnički vjesnik ◽

10.26800/lv-141-5-6-18 ◽

2019 ◽

Vol 141 (5-6) ◽

pp. 134-137

Keyword(s):

Liver Transplantation ◽

Case Report ◽

Portal Vein ◽

Liver Tumors ◽

Splenic Vein ◽

Vena Cava ◽

Portal Blood ◽

Type I ◽

Abernethy Malformation ◽

Congenital Cardiac Anomalies

Abernethy malformation or congenital agenesis of the portal vein (CAPV) is a rare malformation of the abdominal splanchnic venous system. This malformation is commonly found in children and is often associated with other malformations such as congenital cardiac anomalies and skeletal system disorders, as well as liver tumors. There are two types of Abernethy malformation. In type I, portal blood bypasses the liver completely, with the superior mesenteric vein and the splenic vein draining into the inferior vena cava separately (type Ia), or together (type Ib). There are no intrahepatic portal vein branches in the liver. Type II is a partial portocaval shunt in which portal blood partially supplies the liver. There is no unified therapeutic approach for all patients with Abernethy malformation, however, liver transplantation is recommended in patients with liver disease (encephalopathy, poor liver function) and those with liver tumors. In this case report we present a case of Abernethy type Ib malformation in a 17-year-old patient with chronic malaise and uper abdominal pain. During diagnostic work-up, an unresectable liver tumor was found and the patient was successfully treated with orthotopic liver transplantation.

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Epidural venous plexus engorgement due to inferior vena cava thrombosis resulting in cauda equina syndrome: Case report and literature review

Surgical Neurology International ◽

10.4103/sni.sni_115_18 ◽

2018 ◽

Vol 9 (1) ◽

pp. 129 ◽

Cited By ~ 1

Author(s):

TinaW Wong ◽

DanielG Gridley ◽

Iman Feiz-Erfan

Keyword(s):

Case Report ◽

Literature Review ◽

Inferior Vena Cava ◽

Cauda Equina Syndrome ◽

Inferior Vena ◽

Cauda Equina ◽

Vena Cava ◽

Venous Plexus ◽

Vena Cava Thrombosis ◽

Inferior Vena Cava Thrombosis

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Ultrasonic Evaluation of Spontaneous Portosystemic Shunts in Patients with Budd-Chiari Syndrome

Iranian Journal of Radiology ◽

10.5812/iranjradiol.103658 ◽

2020 ◽

Vol In Press (In Press) ◽

Author(s):

Ji-Chen Wang ◽

Shi-Feng Cai ◽

Chen Su ◽

Hui-Li Fan ◽

Yong-Hao Gai ◽

...

Keyword(s):

Inferior Vena Cava ◽

Portal Vein ◽

Inferior Vena ◽

Vena Cava ◽

Main Portal Vein ◽

Budd Chiari Syndrome ◽

Portosystemic Shunts ◽

Chiari Syndrome ◽

Vein Diameter ◽

Portal Trunk

Background: Spontaneous portosystemic shunts (SPSS) are one of the hallmarks of Budd-Chiari syndrome (BCS). Ultrasound can accurately show the location and type of portosystemic collaterals. Objectives: To study the sonographic feature of SPSS in patients with BCS and to evaluate differences in the main portal vein diameter among multiple types of portosystemic shunts. Patients and Methods: Ultrasonographies of 44 patients with SPSS among 352 BCS patients between June 2000 and November 2015 were reviewed retrospectively. The SPSS in 44 BCS patients were first detected by ultrasound and then confirmed via digital subtraction angiography (DSA), computed tomography angiography (CTA) or magnetic resonance venography (MRV). The location, course, diameter and hemodynamics of the spontaneous portosystemic shunts were observed by ultrasound. In addition, one-way analysis of variance (ANOVA) was performed to evaluate the difference in the main portal vein diameter between the different shunt types. Results: The blood drainage patterns of SPSS in 44 of 352 patients with BCS were classified as the following five types: portal-umbilical shunts (15/44), portal-hepatic shunts (11/44), portal-accessory hepatic shunts (6/44) (the accessory hepatic veins included the inferior right hepatic vein and the caudate lobe vein), splenorenal shunts (8/44) and main portal vein-inferior vena cava shunts (4/44). The corresponding hemodynamics of the five types mentioned above were obtained. Main portal vein-inferior vena cava shunts had a significantly larger mean portal trunk diameter compared with all other types (P < 0.05 for all comparisons). In addition, the mean portal trunk diameters in portal-umbilical shunts and portal-hepatic shunts were obviously larger than that of splenorenal shunts (P < 0.05), while there were no statistically significant differences between the other types. Conclusion: Spontaneous portosystemic shunts are not rare in patients with BCS. Ultrasound is a reliable means for their diagnosis and it offers substantial information for use in clinical treatment.

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