Narrowing of the remnant portal vein diameter and decreased portal vein angle are risk factors for portal vein thrombosis after perihilar cholangiocarcinoma surgery

Cao, Manh Thau; Higuchi, Ryota; Yazawa, Takehisa; Uemura, Shuichiro; Izumo, Wataru; Matsunaga, Yutaro; Sato, Yasuto; Morita, Satoru; Furukawa, Toru; Egawa, Hiroto; Yamamoto, Masakazu

doi:10.1007/s00423-020-02044-1

Cited by 8 publications

(5 citation statements)

References 38 publications

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“…The patient's AT-III level remained low. There is also literature indicating that narrowing of the remnant portal vein diameter and a decreased portal vein angle after major hepatectomy for perihilar cholangiocarcinoma are significant independent risk factors for postoperative PVT [20] . A postoperative portal vein angle of less than 90° (the angle of the PV was defined as follows: in right-sided hepatectomy and left-sided hemihepatectomy, the angle formed between the main PV and the first branch of the PV) and a diameter ratio of less than 45% (the diameter ratio was defined as the ratio of the remnant liver PV to the main PV diameter.)…”

Section: Discussionmentioning

confidence: 99%

Recurrent acute portal vein thrombosis with severe abdominal infection after right hemihepatectomy in a patient with perihilar cholangiocarcinoma: A case report and literature review

Deng

Yang

et al. 2022

International Journal of Surgery Case Reports

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Section: Discussionmentioning

confidence: 99%

Recurrent acute portal vein thrombosis with severe abdominal infection after right hemihepatectomy in a patient with perihilar cholangiocarcinoma: A case report and literature review

Deng

Yang

et al. 2022

International Journal of Surgery Case Reports

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“…To investigate the effect of the angulation of the SMV and SV on the hemodynamics in the portal system, the angulation varied from 80° to 120° and the other parameters were unchanged. The fixed velocities at SMV, SV, LGV and IMV inlets were set to be 13.87 cm/s, 18.30 cm/s, 8.00 cm/s and 7.80 cm/s, respectively [ 15 , 18 ]. The RPV and LPV outlets were fixed at 10 mmHg, and the vein walls were assumed to be rigid.…”

Section: Methodsmentioning

confidence: 99%

“…Moreover, the helicity of the helical flow in the portal vein which might be important to minimize the clinical risks of developing thrombus [ 15 ] and it was found to be strongly correlated with the angulation of superior mesenteric vein (SMV) and splenic vein (SV) [ 16 ], indicating that the relationship between PV structure and flow may be of clinical importance. In addition, several liver surgical studies found that the changes in angle of portal vein have an effect on PVT development [ 17 , 18 ]. However, up to now, whether the portal hemodynamics based on the anatomical structure can affect the PVT development in patients with cirrhosis has not yet determined.…”

Section: Introductionmentioning

confidence: 99%

A novel potential mechanism for the development of portal vein thrombosis in cirrhosis based on portal hemodynamics

et al. 2022

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Background Marked changes in hemodynamics have been suggested to be a potential contributing factor to portal vein thrombosis (PVT) development. This study investigated the effect of portal hemodynamics based on the anatomical structure of the portal venous system on PVT development. Methods The morphological features of portal venous system in patients with PVT and those without PVT subgroups were compared. In addition, idealized PV models were established to numerically evaluate the effect of the variation in the angulation of superior mesenteric vein (SMV) and splenic vein (SV) on the hemodynamics of portal venous system. Results The angle α (angulation of SMV and SV) in patients with PVT was lower than that in patients without PVT (p < 0.0001), which was the only independent risk factor (odds ratio (OR), 0.90 (95% CI 0.84–0.95); p < 0.0001) for the presence of PVT. With the change in angle α, the flow pattern of blood flow changed greatly, especially the helical flow. When α = 80°, helical flow only appeared at the local PV near the intersection of SMV and SV. When α = 120°, most regions were occupied by the helical flow. In addition, the h2 gradually increased with increasing α, when α = 80°, h2 = 12.6 m/s2; when α = 120°, h2 = 29.3 m/s2. Conclusions The angulation of SV and SMV was closely associated with PVT development. Helical flow changed following the varying angulation of SV and SMV. Therefore, angulation of SV and SMV may help to identify high-risk cohorts for future PVT development earlier.

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“…Evidence suggests that the geometry of the portal system plays an important role in portal hemodynamics and is therefore closely related to risk of PVT 12–14 . For example, the increase of PV diameter will directly lead to the decrease of PV blood flow velocity and WSS.…”

Section: Introductionmentioning

confidence: 99%

“…Evidence suggests that the geometry of the portal system plays an important role in portal hemodynamics and is therefore closely related to risk of PVT. [12][13][14] For example, the increase of PV diameter will directly lead to the decrease of PV blood flow velocity and WSS. In addition, a reduced angle between SV and SMV leads to a decrease in the spiral flow in the PV, which also increases PVT risk.Therefore,the morphological parameters of these portal systems can be used to rapidly assess PVT risk.…”

Section: Introductionmentioning

confidence: 99%

The effect of splenic vein diameter on the diagnosis of portal vein thrombosis

et al. 2023

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BackgroundIt was still controversial that whether the increase of splenic vein (SV) diameter increased the risk of portal vein thrombosis (PVT), which was a severe disease with high mortality, in the clinic.PurposesThis study, using computational fluid dynamics method, aimed to investigate how the increase of SV diameter affects the portal vein hemodynamics under different anatomical and geometric features of the portal venous system, thus how it induced to PVT.MethodsThe ideal models of the portal system, including different anatomical structures according to the location of left gastric vein (LGV) and inferior mesenteric vein (IMV), and different geometric morphological parameters models were established to carry out numerical simulation in this study. In addition, the morphological parameters of real patients were measured to verify the numerical simulation results.ResultsFirst, the wall shear stress (WSS) and helicity intensity, which were closely related to the occurrence of thrombosis, gradually decreased with the increase of SV diameter in all models. However, the degree of decrease was bigger in following models: (1) the models with LGV and IMV linking to SV compared with them linking to PV; (2) the models with big angle of PV and SV compared with small angle. In addition, the morbidity of PVT was higher when LGV and IMV linked to SV rather than them linked to PV in the real patients. Moreover, the angle of PV and SV was also different between PVT and non‐PVT patients (125.53° ± 16.90° vs. 115.03° ± 16.10°, p = 0.01).ConclusionWhether the increase of SV diameter will result in PVT is depended on the anatomical structure of portal system and the angle between PV and SV, this is also the reason leading to the clinical controversy that the increase of SV diameter is the risk factor of PVT.

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Narrowing of the remnant portal vein diameter and decreased portal vein angle are risk factors for portal vein thrombosis after perihilar cholangiocarcinoma surgery

Cited by 8 publications

References 38 publications

Recurrent acute portal vein thrombosis with severe abdominal infection after right hemihepatectomy in a patient with perihilar cholangiocarcinoma: A case report and literature review

Recurrent acute portal vein thrombosis with severe abdominal infection after right hemihepatectomy in a patient with perihilar cholangiocarcinoma: A case report and literature review

A novel potential mechanism for the development of portal vein thrombosis in cirrhosis based on portal hemodynamics

The effect of splenic vein diameter on the diagnosis of portal vein thrombosis

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