EXTRA-HEPATIC PART OF PORTAL VEIN – A CADAVERIC STUDY IN ADULTS & FOETUSES

Background: Variations of the Hepatic Portal Vein are encountered during abdominal surgeries. Aim: The present study is an observational study of the extrahepatic part of Portal Vein & its variations on cadavers. Materials & Methods: A total of 50 upper abdomen dissections were carried out to delineate extra-hepatic Portal Vein anatomy. The Results: mean length of Portal Vein was 5.96cm. The mean diameter of Portal Vein was 1.35cm. The most common type of formation of Portal Vein was Type I, found in 64%. The Right Gastric Vein commonly emptied into the trunk of the Portal Vein. The Left Gastric Vein commonly emptied into the trunk of the Portal Vein in 87.18%. The most common type of Portal Vein termination was Extra-Hepatic, found in 76% of 50 dissections. The Bifurcation pattern was the most common pattern of Portal Vein termination, found in 94% of dissections. The ndings of the present Conclusion: study highlight the variations that may occur in the hepatic portal venous system in its extra-hepatic part. Sound knowledge of portal venous anatomy is needed for success in the surgeries of the liver & adjacent viscera.

Correlation of Portal and Splenic Vein Diameter with Presence and Size of Esophageal and Gastric Varices in Liver Cirrhosis Patients on MDCT

Introduction: Variceal formation depends upon the pattern of dilatation of the portal and various splanchnic veins in patients with cirrhotic liver and portal hypertension. Multidetector Computed Tomography (MDCT) may be helpful in the evaluation of such gastroesophageal varices and predicting their risk of haemorrhage.Methods: After obtaining ethical clearance and consent, 50 patients meeting the inclusion criteria were included and MDCT obtained. The diameters of the portal vein (PV), splenic vein (SV) and left gastric vein (LGV) were measured and originating vein of LGV determined. Pattern, location and diameter of varix was evaluated. Association between the diameters of the originating vein and the grade and pattern of the esophagael and gastric fundic varices was determined.Results: Of the 50 patients, 41 had gastroesophageal (GE) varices equal to or larger than 1mm with 34% having high-risk varices. The SV was predominantly the originating vein of the LGV. Cutoff SV diameter of 7.75mm and LGV diameter of 5.75mm had a sensitivity of 77.8% with a specificity of 73.2% and 75.6% respectively for the presence of varices.Conclusions: In our study, EV and GEV was more common and mostly supplied by LGV while isolated gastric fundic varices were supplied by non LGV veins only. The diameters of SV and LGV were associated with the presence and grade of esophageal and gastric fundic varices. MDCT is an important non-invasive modality in patients with portal hypertension and should be used for diagnosis, risk stratification and monitoring of varices.

Can the Computed Tomographic Aspect of Porto-Systemic Circulation in Cirrhotic Patients Be Associated with the Presence of Variceal Hemorrhage?

Background and objectives: Variceal bleeding is a serious complication caused by portal hypertension, frequently encountered among cirrhotic patients. The purpose of this study was to determine whether the aspect of the collateral, porto-systemic circulation, as detected by CT are associated with the presence variceal hemorrhage (VH). Materials and Methods: 81 cirrhotic patients who underwent a contrast-enhanced CT examination were retrospectively included in the study. Patients were divided into two groups: Cirrhotic patients with variceal hemorrhage during the hospital admission concomitant, with the CT examination (n = 33) and group 2-cirrhotic patients, without any variceal hemorrhage in their medical history (n = 48). The diameter of the left gastric vein, the presence or absence and dimensions of oesophageal and gastric varices, paraumbilical veins and splenorenal shunts were the indicators assessed on CT. Results: The univariate analysis showed a significant association between the presence of upper GI bleeding and the diameters of paraoesophageal veins, paragastric veins and left gastric vein respectively, all of these CT parameters being higher in patients with variceal bleeding. In the multivariate logistic regression analysis, only the diameter of the left gastric vein was independently associated with the presence of variceal hemorrhage (OR = 1.6 (95% CI: 1.17–2.19), p = 0.003). We found an optimal cut-off value of 3 mm for the diameter of the left gastric vein useful to discriminate among patients with variceal hemorrhage from the ones without it, with a good diagnostic performance (AUC = 0.78, Se = 97%, Sp = 45.8%, PPV = 55.2%, NPV = 95.7%). Conclusions: Our observations point out that an objective CT quantification of porto-systemic circulation can be correlated with the presence of variceal hemorrhage and the diameter of the left gastric vein can be a reliable parameter associated with this condition.

”Left gastric vein to inferior vena cava” bypass in patients with portal hypertension

Aim. To present the first Russian experience in the management of portal hypertension of various etiology by creating a selective portosystemic shunt between left gastric vein and inferior vena cava (leftgastric vein caval bypass).Material and methods. “Left gastric vein to inferior vena cava” bypass was performed in 6 patients with portal hypertension: 4 men and 2 women (mean age 40.4 years). The follow-up period ranged from 10 to 36 months.Results. “Left gastric vein to inferior vena cava” bypass was effective in the management of portal hypertension and its complications in 5 out of 6 patients. Complete eradication of esophagogastric varices and no variceal bleeding were observed in long-term period. These patients demonstrated no clinical or laboratory signs of hepatic encephalopathy and/or hepatic failure within the follow-up. One patient with thrombophilia and extrahepatic portal vein obstruction (factor V Leiden mutation) had thrombosis of the shunt and recurrent variceal bleeding in 6 months after surgery because of unauthorized abandonment of the anticoagulation.Conclusion. “Left gastric vein to inferior vena cava” bypass is an effective procedure for prevention of variceal bleeding (or recurrence) in patients with portal hypertension. The limitation of this technique is insufficient diameter of left gastric vein in many patients. This procedure has certain pathophysiological advantages over other types of portosystemic anastomoses due to highly selective nature of the shunt. Thus, this approach should be introduced into surgical treatment of these patients.