Preconditioning by portal vein embolization modulates hepatic hemodynamics and improves liver function in pigs with extended hepatectomy

Asencio, José Manuel; García-Sabrido, J.L.; López-Baena, José Ángel; Olmedilla, Luis; Peligros, Isabel; Rojas, Pilar; Morales-Taboada, Álvaro; Fernández-Mena, Carolina; Steiner, M.; Sola, Emma; Pérez-Peña, Jose; Herrero, Miriam; Laso, Juan; Lisbona, Cristina; Bañares, Rafael; Casanova, Javier

doi:10.1016/j.surg.2016.12.003

Cited by 17 publications

(20 citation statements)

References 35 publications

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“…The clinical measurements of hepatic microcirculation showed no microvascular flow differences in the embolized lobes compared to the lobes in the control group, indicating that the mechanism to correct microvascular flow in the embolized lobe had succeeded. Asencio et al also did not find any differences in hepatic arterial blood flow between the embolized and non-embolized lobes in pigs 24 h after embolization, 37 indicating an immediate response of the liver to unilateral portal vein occlusion. In the current clinical study the microcirculatory effects of PVE after approx.…”

Section: Discussionmentioning

confidence: 90%

Assessment of hepatic microvascular flow and density in patients undergoing preoperative portal vein embolization

İnce

Rassam

et al. 2019

HPB

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Section: Discussionmentioning

confidence: 90%

Assessment of hepatic microvascular flow and density in patients undergoing preoperative portal vein embolization

İnce

Rassam

et al. 2019

HPB

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“…However, this is the case up to a limit, with regional variation within the parenchyma [26]. Edema and periportal exsanguination are seen after partial hepatectomy in small-for-size remnants but were also seen where the liver functions were preserved [27].…”

Section: Discussionmentioning

confidence: 99%

Kinetics of Hepatic Volume Evolution and Architectural Changes after Major Resection in a Porcine Model

et al. 2019

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Background: The hepatic volume gain following resection is essential for clinical recovery. Previous studies have focused on cellular regeneration. This study aims to explore the rate of hepatic regeneration of the porcine liver following major resection, highlighting estimates of the early microarchitectural changes that occur during the cellular regeneration. Methods: Nineteen large white pigs had 75% resection with serial measurements of the hepatic volume, density, blood flow, and architectural changes. Results: The growth rate initially was 45% per day, then rapidly decreased and was accompanied by a similar pattern of hepatic fat deposition. The architectural changes showed a significant increase in the Ki67 expression (p < 0.0001) in the days following resection with a peak on the 2nd day and nearly normalized on day 7. The expression of CD31 increased significantly on the 2nd and 3rd days compared to the pre-resection samples (p = 0.03). Hepatic artery flow per liver volume remained at baseline ranges during regeneration. Portal flow per liver volume increased after liver resection (p < 0.001), was still elevated on the 1st postoperative day, then decreased. Correlations were significantly negative between the hepatic volume increase on day 3 and the hepatic oxygen consumption and the net lactate production at the end of the procedure (r = –0.82, p = 0.01, and r = –0.70, p = 0.03). Conclusion: The volume increase in the first days – a fast process – is not explained by cellular proliferation alone. The liver/body weight ratio is back to 50% of the preoperative value after 3 days to close to 100% volume regain on days 10–15.

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“…91,92 One of the strategies used to prevent this syndrome is portal vein embolization 4 to 6 weeks prior to hepatectomy, which gives time for the perfused segments of the liver to undergo hypertrophy, effectively increasing the functional liver remnant at the time of hepatectomy. 93,94 Naturally, a prerequisite for this approach is a capable interventional radiology (IR) department working in coordination with the hepatobiliary surgeon. Another option to prevent this has been explored in experimental settings, where a portocaval shunt at the time of resection decreased sinusoidal edema and improved survival.…”

Section: Surgical Portosystemic Shunts In Liver Resectionsmentioning

confidence: 99%

Surgical Portosystemic Shunts: History, Evolution, and Current Applications

López‐Verdugo

Sánchez-García

Gagnon

et al. 2020

Digestive Disease Interventions

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AbstractMechanical obstruction, thrombus, intrinsic liver disease causing fibrosis or cirrhosis, or an outflow obstruction at the level of the sinusoids or hepatic venous obstruction can cause an increase in pressure or resistance, or both, leading to portal hypertension (PH). Portosystemic shunts (PSS) are usually performed to relieve the congestion that inevitably occurs in the setting of PH. Since their introduction, surgical PSS were often the treatment of choice to prevent recurrent bleeding in patients with clinically significant PH. Development of novel pharmacological therapies, continuous improvement of endoscopic approaches, the introduction of transjugular intrahepatic portosystemic shunt, and advancements in transplantation has provided an evolution in the approach for PH and has precipitated the steady decrease in the proportion of patients needing surgical shunts. Despite this, PSS remain important tools in the surgeon's armamentarium, as they are often employed in the pediatric population with extrahepatic portal vein obstruction and are frequently being used for portal inflow modulation to achieve better portal hemodynamics in resections and transplantation. This has become of great relevance to decrease the risk of small-for-size syndrome and portal hyperperfusion in liver transplantation, and to decrease the risk of posthepatectomy liver dysfunction after major resections in hepatobiliary surgery.

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Preconditioning by portal vein embolization modulates hepatic hemodynamics and improves liver function in pigs with extended hepatectomy

Cited by 17 publications

References 35 publications

Assessment of hepatic microvascular flow and density in patients undergoing preoperative portal vein embolization

Assessment of hepatic microvascular flow and density in patients undergoing preoperative portal vein embolization

Kinetics of Hepatic Volume Evolution and Architectural Changes after Major Resection in a Porcine Model

Surgical Portosystemic Shunts: History, Evolution, and Current Applications

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