scholarly journals The Frequency and Significance of Portopulmonary Venous Anastomosis (PPVA) and Transvenous Obliteration for Gastric Varices

2018 ◽  
Vol 2 (1) ◽  
pp. 01-03
Author(s):  
Laxmisamhitha Bontha
Keyword(s):  
High Resolution ◽  
Literature Review ◽  
Gastric Varices ◽  
Extensive Literature ◽  
Venous Anastomosis ◽  
Gastroesophageal Varices ◽  
Vascular Connection ◽  
Advanced Cirrhosis ◽  
Cirrhotic Patients ◽  
Clinically Significant

A Portopulmonary Venous Anastomosis (PPVA) is a direct vascular connection between the portal venous system and the pulmonary veins, close to the left atrium. We describe a patient with advanced cirrhosis and moderately severe Hepatopulmonary Syndrome (HPS) in whom (PPVA) was demonstrated by a high resolution computed tomographic scan. In order to reduce the symptoms of hypoxia in our patient, we sequentially performed Transjugular Intrahepatic Portosystemic Shunt (TIPS) followed by a catheter based obliteration of the PPVA. The case raised three questions which were addressed through an extensive literature review. Among patients with advanced cirrhosis, what is the frequency of PPVA? Our literature review suggests that the frequency of finding a PPVA in patients with portal hypertension depends on the imaging technique used. Transhepatic or transvenous portal venography may demonstrate PPVA in about 20% of patients with cirrhosis and varices. Limited published experience with contrast enhanced (bubble) echocardiography suggests that PPVA may be present in about 30% of such patients. An increasing number of case reports of PPVA have been published in recent years. This observation indicates that routine use of High Resolution Computed Tomography (HRCT) and magnetic resonance imaging is able to identify PPVA in cirrhotic patients. The visualization of PPVA with HRCT depends on the timing of the contrast injection and the expertise of the viewer. The present report describes three patients with portopulmonary venous anastomosis (PPVA) in whom balloon-occluded retrograde transvenous obliteration (B-RTO) of gastric varices was attempted. No patients had a gastrorenal shunt. In one patient, after an approach from the inferior phrenic vein (IPV), the PPVA was embolized with the use of microcoils. Portopulmonary Venous Anastomosis Detected at Balloon-occluded Retrograde Transvenous Obliteration for Gastric Varices among cirrhotic patients with PPVA, what is the clinical significance of the PPVA? There are multiple causes of clinically significant hypoxia in patients with cirrhosis. A PPVA is a right to left shunt that, theoretically, could be associated with clinically significant systemic arterial hypoxemia or emboli. There is not definitive evidence in the published literature that PPVA alone causes clinically significant hypoxia in cirrhotic patients. PPVA is, however, a documented important risk factor for systemic emboli when needle or catheter techniques are used to treat or prevent bleeding from gastroesophageal varices.

scholarly journals Efficacy of CTPV for Diagnostic and Therapeutic Assessment: Comparison with Endoscopy in Cirrhotic Patients with Gastroesophageal Varices

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Zijin Cui ◽  
Haiqing Yang ◽  
Xiaoxu Jin ◽  
Huiqing Jiang ◽  
Wei Qi ◽  
...  
Keyword(s):  
Therapeutic Efficacy ◽  
Statistical Significance ◽  
Gastric Varices ◽  
Variceal Hemorrhage ◽  
Gastroesophageal Varices ◽  
Exact Test ◽  
Less Invasive ◽  
Kappa Test ◽  
Cirrhotic Patients

Background and Aims. Computed tomography portal venography (CTPV) shows potential in detecting varices that need treatment and their drainage pathways. However, its agreement with endoscopy requires further study. We investigated the feasibility of CTPV as an alternative tool to endoscopy in screening gastroesophageal varices (GEVs) and developed a CTPV-based model to provide a less invasive assessment of endotherapy for cirrhotic patients with GEVs. Methods. The study included 33 cirrhotic patients with a recent history of variceal hemorrhage. The presence, grade, and classification of GEVs on endoscopy and CTPV were compared (kappa test). Twenty-four patients were treated endoscopically, including 12 for esophageal varices (EVs), 8 for gastric varices (GVs), and 4 for GEVs. Treatment efficacies were assessed with the newly developed CTPV-based method at 1 week and 1 month after treatment. Efficiency evaluated by CTPV and endoscopy was compared by Fisher’s exact test to determine whether CTPV is efficient in the assessment of endotherapy efficacy. Results. For the screening and grading/classification of EVs and GVs, substantial agreement (EV kappa: 0.63 and 0.68; GV kappa: 0.62 and 0.75, respectively) was noted between endoscopy and CTPV. The therapeutic efficacy of EVs was higher when assessed by CTPV than when evaluated by endoscopy (37.50% vs. 12.50% at 1 week postoperation, P=0.22; 62.50% vs. 25.00% at 1 month postoperation, P=0.07), but without statistical significance. The same trend was also found in the assessment of therapeutic efficacy for GVs (25.00% vs. 16.67% at 1 week postoperation, P=1; 58.33% vs. 41.67% at 1 month postoperation, P=0.68). Conclusion. CTPV is comparable to endoscopy in the detection of GEVs and in the evaluation of endotherapy efficacy, which suggests that it could be a less invasive alternative for endoscopy in cirrhotic patients with GEVs needing treatment.

scholarly journals Managing liver cirrhotic complications: Overview of esophageal and gastric varices

2020 ◽  
Vol 26 (4) ◽  
pp. 444-460 ◽  
Author(s):  
Cosmas Rinaldi Adithya Lesmana ◽  
Monica Raharjo ◽  
Rino A. Gani
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Variceal Bleeding ◽  
Portal Pressure ◽  
Gastric Varices ◽  
Non Invasive ◽  
Esophagogastric Varices ◽  
Cirrhotic Patients ◽  
Clinically Significant ◽  
Gradient Measurement

Managing liver cirrhosis in clinical practice is still a challenging problem as its progression is associated with serious complications, such as variceal bleeding that may increase mortality. Portal hypertension (PH) is the main key for the development of liver cirrhosis complications. Portal pressure above 10 mmHg, termed as clinically significant portal hypertension, is associated with formation of varices; meanwhile, portal pressure above 12 mmHg is associated with variceal bleeding. Hepatic vein pressure gradient measurement and esophagogastroduodenoscopy remain the gold standard for assessing portal pressure and detecting varices. Recently, non-invasive methods have been studied for evaluation of portal pressure and varices detection in liver cirrhotic patients. Various guidelines have been published for clinicians’ guidance in the management of esophagogastric varices which aims to prevent development of varices, acute variceal bleeding, and variceal rebleeding. This writing provides a comprehensive review on development of PH and varices in liver cirrhosis patients and its management based on current international guidelines and real experience in Indonesia.

scholarly journals Efficacy and safety of combined endoscopic cyanoacrylate injection and balloon-occluded retrograde transvenous occlusion (BRTOcc) of gastrorenal shunts in patients with bleeding gastric fundal varices

2020 ◽  
Author(s):  
Fateh Bazerbachi ◽  
Akira Dobashi ◽  
Swarup Kumar ◽  
Sanjay Misra ◽  
Navtej S Buttar ◽  
...  
Keyword(s):  
Adverse Events ◽  
Gastric Varices ◽  
High Rate ◽  
Efficacy And Safety ◽  
Cyanoacrylate Glue ◽  
Serious Adverse Events ◽  
Gastroesophageal Varices ◽  
Life Threatening ◽  
Glue Embolization

Abstract Background Endoscopic cyanoacrylate (glue) injection of fundal varices may result in life-threatening embolic adverse events through spontaneous gastrorenal shunts (GRSs). Balloon-occluded retrograde transvenous occlusion (BRTOcc) of GRSs during cyanoacrylate injection may prevent serious systemic glue embolization through the shunt. This study aimed to evaluate the efficacy and safety of a combined endoscopic–interventional radiologic (BRTOcc) approach for the treatment of bleeding fundal varices. Methods We retrospectively analysed the data of patients who underwent the combined procedure for acutely bleeding fundal varices between January 2010 and April 2018. Data were extracted for patient demographics, clinical and endoscopic findings, technical details, and adverse events of the endoscopic–BRTOcc approach and patient outcomes. Results We identified 30 patients (13 [43.3%] women; median age 58 [range, 25–92] years) with gastroesophageal varices type 2 (53.3%, 16/30) and isolated gastric varices type 1 (46.7%, 14/30) per Sarin classification, and median clinical and endoscopic follow-up of 151 (range, 4–2,513) days and 98 (range, 3–2,373) days, respectively. The median volume of octyl-cyanoacrylate: Lipiodol injected was 7 (range, 4–22) mL. Procedure-related adverse events occurred in three (10.0%) patients, including transient fever, non-life-threatening pulmonary glue embolism, and an injection-site ulcer bleed. Complete gastric variceal obturation was achieved in 18 of 21 patients (85.7%) at endoscopic follow-up. Delayed variceal rebleeding was confirmed in one patient (3.3%) and suspected in two patients (6.7%). Although no procedure-related deaths occurred, the overall mortality rate was 46.7%, primarily from liver-disease progression and co-morbidities. Conclusion The combined endoscopic–BRTOcc procedure is a relatively safe and effective technique for bleeding fundal varices, with a high rate of variceal obturation and a low rate of serious adverse events.

scholarly journals Forest Aboveground Biomass Estimation and Mapping through High-Resolution Optical Satellite Imagery—A Literature Review

Forests ◽  
2021 ◽  
Vol 12 (7) ◽  
pp. 914
Author(s):  
Adeel Ahmad ◽  
Hammad Gilani ◽  
Sajid Rashid Ahmad
Keyword(s):  
High Resolution ◽  
Literature Review ◽  
Satellite Imagery ◽  
Aboveground Biomass ◽  
Vegetation Indices ◽  
Biomass Estimation ◽  
Independent Variables ◽  
Non Linear ◽  
Multiple Variables ◽  
Forest Aboveground Biomass

This paper provides a comprehensive literature review on forest aboveground biomass (AGB) estimation and mapping through high-resolution optical satellite imagery (≤5 m spatial resolution). Based on the literature review, 44 peer-reviewed journal articles were published in 15 years (2004–2019). Twenty-one studies were conducted across six continents in Asia, eight in North America and Africa, five in South America, and four in Europe. This review article gives a glance at the published methodologies for AGB prediction modeling and validation. The literature review suggested that, along with the integration of other sensors, QuickBird, WorldView-2, and IKONOS satellite images were most widely used for AGB estimations, with higher estimation accuracies. All studies were grouped into six satellite-derived independent variables, including tree crown, image textures, tree shadow fraction, canopy height, vegetation indices, and multiple variables. Using these satellite-derived independent variables, most of the studies used linear regression (41%), while 30% used linear (multiple regression and 18% used non-linear (machine learning) regression, while very few (11%) studies used non-linear (multiple and exponential) regression for estimating AGB. In the context of global forest AGB estimations and monitoring, the advantages, strengths, and limitations were discussed to achieve better accuracy and transparency towards the performance-based payment mechanism of the REDD+ program. Apart from technical limitations, we realized that very few studies talked about real-time monitoring of AGB or quantifying AGB change, a dimension that needs exploration.

scholarly journals No Association of Homocysteine, Anticardiolipin Antibody, and Anti-β2 Glycoprotein I Antibody With Portal Venous System Thrombosis in Liver Cirrhosis

2021 ◽  
Vol 27 ◽  
pp. 107602962110109
Author(s):  
Le Wang ◽  
Xiaozhong Guo ◽  
Xiangbo Xu ◽  
Shixue Xu ◽  
Juqiang Han ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Vein ◽  
Anticardiolipin Antibody ◽  
Venous System ◽  
Common Complication ◽  
Portal Venous System ◽  
Main Portal Vein ◽  
Glycoprotein I ◽  
Cirrhotic Patients ◽  
Clinically Significant

Portal venous system thrombosis (PVST), a common complication of liver cirrhosis, is closely associated with thrombophilia. To explore the association of homocysteine (Hcy), anticardiolipin antibody (aCL), and anti-β2 glycoprotein I antibody (aβ2GPI), which are possible thrombophilic factors, with PVST in liver cirrhosis. Overall, 654 non-malignant patients (219 with and 435 without liver cirrhosis) admitted between January 2016 and June 2020 were retrospectively evaluated. Presence of PVST, degree of main portal vein (MPV) thrombosis, and clinically significant PVST were identified. Hcy level, hyperhomocysteinemia (HHcy), aCL positivity, and aβ2GPI positivity were compared according to the presence of liver cirrhosis and PVST. Positive aβ2GPI was significantly more frequent in patients with liver cirrhosis than those without, but Hcy level and proportions of HHcy and positive aCL were not significantly different between them. PVST could be evaluated in 136 cirrhotic patients. Hcy level [10.57 μmol/L (2.71-56.82) versus 9.97 μmol/L (2.05-53.44); P = 0.796] and proportions of HHcy [4/44 (9.1%) versus 13/81 (16.0%); P = 0.413] and positive aCL [1/23 (4.3%) versus 10/52 (19.2%); P = 0.185] and aβ2GPI [9/23 (39.1%) versus 21/52 (40.4%); P = 0.919] were not significantly different between cirrhotic patients with and without PVST. There was still no significant association of Hcy level, HHcy, aCL, or aβ2GPI with PVST based on Child-Pugh classification, MPV thrombosis >50%, and clinically significant PVST. Hcy, aCL, and aβ2GPI may not be associated with PVST in liver cirrhosis, suggesting that routine screening for Hcy, aCL, and aβ2GPI should be unnecessary in such patients.

Die kognitive Legitimität aus Kundensicht im Kontext neuer Unternehmen

2021 ◽  
Author(s):  
Miriam Lohrmann
Keyword(s):  
Literature Review ◽  
Three Dimensional ◽  
Dimensional Structure ◽  
Extensive Literature ◽  
Extensive Literature Review ◽  
New Business ◽  
Potential Customers ◽  
Cognitive Legitimacy

Customer cognitive legitimacy is an important factor in a new business venture’s survival. Based on an extensive literature review of customer cognitive legitimacy, this book examines the consistent conceptualisation of the concept and its dimensional structure. This consistent conceptualisation facilitates the development of the reliable and valid three-dimensional customer cognitive legitimacy scale in 10 studies. The scale is based on potential customers’ interest in acquiring knowledge about a product and the company responsible for it, their perception of the company’s and the product’s future, and their perception of how competent the company’s managers are.

Sign in / Sign up

Export Citation Format

Share Document