Association Between Changes in Splanchnic Hemodynamics and Risk Factors of Portal Venous System Thrombosis After Splenectomy with Periesophagogastric Devascularization

Abstract

BackgroundThe purpose of this study was to investigate splanchnic hemodynamic changes and determine an optimal cutoff value for risk factors of portal venous system thrombosis (PVST) after splenectomy with periesophagogastric devascularization (SPD) in cirrhotic patients with esophageal and gastric variceal bleeding (EGVB) and portal hypertension (PH).Material/MethodsData on patients who underwent SPD were collected retrospectively from January 2013 to December 2017. Color Doppler ultrasound was performed to detect hemodynamic changes of the hepatic artery, splenic artery, splenic vein, and portal vein in included patients (n=60) and healthy volunteers (n=30). Outcomes were compared between preoperative and postoperative biochemical indicators. The cutoff values for hemodynamics were identified using receiver operating characteristic (ROC) curve analysis, and univariate and multivariate analyses of risk factors of PVST were performed.ResultsIn our series, hemodynamic indexes of splenic artery, spleen vein, and portal vein in the study group were significantly higher than that of the control group (P<0.05). Multivariate analysis revealed that the portal vein flow and the internal diameter of the portal vein were significantly correlated with PVST. The ROC analysis revealed that the cutoff points for portal vein flow and internal diameter of the splenic vein and portal vein were ≥1822.32 ml/min, ≥1.37 cm, and ≥1.56 cm, respectively.ConclusionsSPD is an effective treatment in cirrhotic patients with concomitant EGVB and PH by increasing hepatic artery flow and decreasing portal vein flow. High portal vein flow and wider diameters of the portal vein and splenic vein are important markers of PVST.

Long‐term outcomes of oesophagogastric devascularization and splenectomy in patients with portal hypertension and liver cirrhosis

“…Liver function improvements may be due to the changes of splanchnic haemodynamics, namely, decrease of flow and velocity in portal vein and increase of flow and velocity in hepatic artery. 23 The decrease of total bilirubin after operation could result from the cessation of haemolytic reaction that occurs in the splenic parenchyma owing to hypersplenism. In addition, the reduction in total bilirubin could reflect a better functional hepatic reserve following the decrease of portal pressure.…”

“…Levels of AST and total bilirubin decreased and albumin increased with a statistical difference 1 year after surgery. Liver function improvements may be due to the changes of splanchnic haemodynamics, namely, decrease of flow and velocity in portal vein and increase of flow and velocity in hepatic artery 23 . The decrease of total bilirubin after operation could result from the cessation of haemolytic reaction that occurs in the splenic parenchyma owing to hypersplenism.…”

Influences of Anatomorphological Features of the Portal Venous System on Postsplenectomy Hemodynamic Characteristics in Patients With Portal Hypertension: A Computational Model-Based Study

“…These results indicate that the anatomical structure and some morphogeometrical parameters (e.g., the diameter and curvature of the SV, and the distance between the IMV and splenoportal junction) of the PVS can significantly affect postoperative ALS and associated risk of postsplenectomy thrombosis. The marked increase in postoperative ALS associated with 'C'(+) variation may provide biomechanical evidence for explaining the clinical observation that patients with a larger diameter of the SV were at increased risk of developing thrombosis after splenectomy (Danno et al, 2009;Kinjo et al, 2010;de'Angelis et al, 2017;Huang et al, 2018). However, clinical studies on the correlations between the anatomical structure or other morphogeometrical features of the PVS and the risk of postsplenectomy thrombosis remain absent.…”

“…In this context, some studies turned to investigating other factors that are related to hemodynamic conditions in the portal venous system (PVS). For instance, it was found that patients with a larger diameter of the splenic vein (SV) or the portal vein (PV) had a higher risk of developing postsplenectomy thrombosis (Danno et al, 2009;Kinjo et al, 2010;de'Angelis et al, 2017;Huang et al, 2018). The study by Huang et al (2018) further demonstrated that a higher preoperative flow rate in the PV was an independent risk factor of postsplenectomy thrombosis.…”

“…For instance, it was found that patients with a larger diameter of the splenic vein (SV) or the portal vein (PV) had a higher risk of developing postsplenectomy thrombosis (Danno et al, 2009;Kinjo et al, 2010;de'Angelis et al, 2017;Huang et al, 2018). The study by Huang et al (2018) further demonstrated that a higher preoperative flow rate in the PV was an independent risk factor of postsplenectomy thrombosis. The correlations of these factors with the risk of postsplenectomy thrombosis have been considered to be mediated by their influences on hemodynamic characteristics (i.e., flow disturbance or flow stagnation) that increase coagulation ability in the PVS after splenectomy (Winslow et al, 2002).…”