Effects of Combined Therapy Using Partial Splenic Embolization and Transjugular Retrograde Obliteration on Systemic Hemodynamics in Patients With Gastric Varices and a Splenorenal Shunt

Chikamori, Fumio; Okamoto, Hiroshi; Kuniyoshi, Nobutoshi; Takase, Yasuhiro

doi:10.1097/sle.0b013e318275745a

Cited by 6 publications

(3 citation statements)

References 27 publications

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“…Partial splenic embolization can reduce the SVF and WHVP [22]. Our preliminary report [23] showed that the combined therapy using partial splenic embolization and TJO reduced the SVF and stopped SRS flow, which improved the C(a-v) O 2 . However, the effect of TJO or partial splenic embolization on systemic hemodynamics is still unclear.…”

Section: Discussionmentioning

confidence: 99%

Relationships between Splenorenal Shunt/Portal Vein Diameter Ratio and Systemic Hemodynamics in Patients with Liver Cirrhosis

Chikamori¹,

Okamoto²,

Kuniyoshi³

2014

Digestion

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Objectives: The purpose of this study was to investigate the relationships between the splenorenal shunt (SRS)/portal vein (PV) diameter ratio (SRS/PV ratio) and systemic hemodynamics in patients with liver cirrhosis. Patients and Methods: Thirty-seven patients with SRS due to liver cirrhosis were included in this study. SRS was evaluated in the retropancreatic space on contrast-enhanced CT and the diameter was measured at the maximum point. Systemic hemodynamics was studied using a thermodilution catheter. Results: The SRS/PV ratio showed a significant correlation with the cardiac index (p < 0.01), and showed an inverse correlation with the systemic vascular resistance index and the arteriovenous oxygen content difference [C(a-v)O₂] (p < 0.01). The Child-Pugh score showed a correlation with the SRS/PV ratio (p < 0.01). The SRS/PV ratio was 0.89 ± 0.52, 1.02 ± 0.51, and 1.74 ± 0.50 in the Child-Pugh A, B, and C classes, respectively. The SRS/PV ratio in the Child-Pugh C class was significantly higher than those in classes A and B (p < 0.01). The plasma ammonia level was 75.3 ± 23.2 in the group with an SRS/PV ratio <1.0 (n = 19) versus 102.6 ± 34.8 in the group with an SRS/PV ratio ≥1.0 (n = 18), and the ratio of encephalopathy was 5% (1/19) in the group with an SRS/PV ratio <1.0 (n = 19) versus 50% (9/18) in the group with an SRS/PV ratio ≥1.0 (n = 18), respectively. The differences between the two groups were statistically significant (p < 0.01). Conclusions: We conclude that the increase in the SRS/PV ratio is accompanied by deteriorated liver function, hyperdynamic status, and narrowed C(a-v)O₂.

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Section: Discussionmentioning

confidence: 99%

Relationships between Splenorenal Shunt/Portal Vein Diameter Ratio and Systemic Hemodynamics in Patients with Liver Cirrhosis

Chikamori¹,

Okamoto²,

Kuniyoshi³

2014

Digestion

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Section: Guidelines For Treatment Of Aberrant Portal Hemodynamicsmentioning

confidence: 99%

“…When symptoms associated with splenomegaly (abdominal pain and compression) or a tendency to bleed and severely decreased blood cells (at least one of the following: platelets, ≤5 × 10 4 ; white blood cells, ≤3000; and red blood cells, ≤300 × 10 4 ) associated with splenomegaly, partial splenic embolization or splenectomy should be considered. 19,106,[136][137][138][139][146][147][148]167,168,[180][181][182][183][184][185][186][187][188][189][190][191][192][193] Guidelines for treatment of stenosis and obstruction in BCS Obstruction or stenosis of the main trunk of the hepatic vein or the hepatic segment of the inferior vena cava should be treated by recanalization or dilatation with a catheter, stent placement, surgery to directly eliminate the obstruction and stenosis, or a shunt operation between the upper and lower sites of obstruction and stenosis of the vena cava. 131,[194][195][196][197][198][199][200][201][202][203][204][205][206] In acute cases with thrombus obstruction up to the peripheral part of the hepatic vein, the liver resection and peripheral hepatic vein-right atrium anastomosis may be an option.…”

Section: Guidelines For Treatment Of Splenomegaly and Hypersplenismmentioning

confidence: 99%

Diagnosis and treatment guidelines for aberrant portal hemodynamics

Furuichi

Tanaka

Takikawa

et al. 2017

Hepatology Research

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Idiopathic portal hypertension (IPH), causing aberrant portal hemodynamics, is a disease with an as yet unidentified cause and no established treatment protocol. The Japanese research group on IPH in Japan was set up in 1975 by the Ministry of Health, Labor and Welfare. Extrahepatic portal obstruction and Budd-Chiari syndrome (BCS) have since been added to the group's research subjects. The aims of the research group are to accurately evaluate the current status of the three diseases in Japan, elucidate their etiology and pathogenesis, and develop new treatments. Due to the long-term efforts of the Japanese research group, aberrant portal hemodynamics has been investigated in a variety of aspects, from epidemiological and pathological studies to molecular biology analyses. As a result, it has been shown that there are abnormal genes in the liver, specific for IPH. In addition, pathological findings of BCS were internationally compared and the difference in findings between Japan and Europe (or North America) has been clarified. Furthermore, it was found that complication rates of hepatocellular carcinoma in BCS were higher in Japan. Based on the research, "Diagnosis and treatment of aberrant portal hemodynamics (2001)", including diagnostic criteria for aberrant portal hemodynamics, was published in 2001. In 2013, it was revised to "Diagnosis and treatment guidelines for aberrant portal hemodynamics (2013)" after the incorporation of diagnosis and treatment in accordance with its current status.

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Comparison of TIPS alone and combined with partial splenic embolization (PSE) for the management of variceal bleeding

Wan

et al. 2019

Eur Radiol

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Effects of Combined Therapy Using Partial Splenic Embolization and Transjugular Retrograde Obliteration on Systemic Hemodynamics in Patients With Gastric Varices and a Splenorenal Shunt

Abstract: : We conclude that the combined therapy using PSE and TJO reduces the splenic venous flow and stops the splenorenal shunt flow, which improves the arterio-venous oxygen content difference.

Cited by 6 publications

References 27 publications

Relationships between Splenorenal Shunt/Portal Vein Diameter Ratio and Systemic Hemodynamics in Patients with Liver Cirrhosis

Relationships between Splenorenal Shunt/Portal Vein Diameter Ratio and Systemic Hemodynamics in Patients with Liver Cirrhosis

Diagnosis and treatment guidelines for aberrant portal hemodynamics

Comparison of TIPS alone and combined with partial splenic embolization (PSE) for the management of variceal bleeding

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