Restructuring of the vascular bed in response to hemodynamic disturbances in portal hypertension

Garbuzenko, Dmitry Victorovich; Arefyev, Nikolay Olegovich; Belov, D.V.

doi:10.4254/wjh.v8.i36.1602

Cited by 11 publications

(8 citation statements)

References 52 publications

(51 reference statements)

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“…6 It has been reported that dozens of factors such as the hemodynamic changes, blood hypercoagulable state, and irrational use of coagulation drugs are associated with PVT. 7–9 In general, the initial symptoms of PVT are not obvious. It cannot be confirmed by imaging examination at early stage and is easy to be misdiagnosed or missed.…”

Section: Introductionmentioning

confidence: 99%

P-Selectin Level at First and Third Day After Portal Hypertensive Splenectomy for Early Prediction of Portal Vein Thrombosis in Patients With Cirrhosis

Wei

Chen

Shen

et al. 2018

Clin Appl Thromb Hemost

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We aimed to investigate the changes in p-selectin (p-sel), thrombus precursor protein, and D-dimer (D-D) in patients with cirrhosis after portal hypertensive splenectomy and explore its values on the prediction of postoperative portal vein thrombosis (PVT) formation. A total of 144 patients with cirrhosis with portal hypertension who underwent portal hypertensive splenectomy from January 2009 to December 2016 were enrolled in this study and divided into the thrombus and nonthrombus groups. The levels of p-sel, thrombus precursor protein (TpP), and D-D were measured by flow cytometry, enzyme-linked immunosorbent assay, and immunoturbidimetry, respectively. Sensitivity, specificity, and other values for p-sel, TpP, and D-D were calculated. The linear discriminant, logistic regression, and decision tree methods were used to analyze the p-sel value on the prediction of PVT formation. Seventy-nine patients were confirmed having postoperative PVT, with the incidence rate of 54.86%. No significant differences were observed in the p-sel, TpP, and D-D between the thrombus and nonthrombus groups before surgery, but these 3 indexes were obviously elevated in the thrombus group after operation ( P < .01). P-selectin level on first day showed the highest positive predictive value (91.0%) and diagnostic coincidence rate (83.3%), while negative expected value (76.6%) was lower than those of TpP and D-D. Multiple analyses showed the prediction accuracy of PVT was 61.1% ( P = .023), 97.2% ( P < .001), and 97.2% ( P < .001), respectively. P-selectin has a significant value in predicting PVT. P-selectin level on first and third day is valuable and feasible for the early prediction of PVT.

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Section: Introductionmentioning

confidence: 99%

P-Selectin Level at First and Third Day After Portal Hypertensive Splenectomy for Early Prediction of Portal Vein Thrombosis in Patients With Cirrhosis

Wei

Chen

Shen

et al. 2018

Clin Appl Thromb Hemost

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“…This leads to PH progression and the occurrence of related complications, particularly variceal bleeding (Figure 1). 3 …”

Section: Pathophysiological Mechanisms Of Portal Hypertension In Livementioning

confidence: 99%

Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis: An update and review of the literature

Garbuzenko

Arefyev

2020

J Evidence Based Medicine

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All patients with liver cirrhosis and portal hypertension should be stratified by risk groups to individualize different therapeutic strategies to increase the effectiveness of treatment. In this regard, the development of primary prophylaxis of variceal bleeding and its management according to the severity of portal hypertension may be promising. This paper is to describe the modern principles of primary prophylaxis of esophageal variceal bleeding in patients with liver cirrhosis. The PubMed and EMbase databases, Web of Science, Google Scholar, and the Cochrane Database of Systematic Reviews were used to search for relevant publications from 1999 to 2019. The results suggested that depending on the severity of portal hypertension, patients with cirrhosis should be divided into those who need preprimary prophylaxis, which aims to prevent the formation of esophageal varices, and those who require measures that aim to prevent esophageal variceal bleeding. In subclinical portal hypertension, therapy should be etiological and pathogenetic. Cirrhosis with clinically significant portal hypertension should receive nonselective β‐blockers if they have small esophageal varices and risk factors for variceal bleeding. Nonselective β‐blockers are the first‐line drugs for the primary prevention of bleeding from medium to large‐sized esophageal varices. Endoscopic band ligation is indicated for the patients who are intolerant to nonselective β‐blockers or in the case of contraindications to pharmacological therapy. In summary, the stratification of cirrhotic patients by the severity of portal hypertension and an individual approach to the choice of treatment may increase the effectiveness of therapy as well as improve survival rate of these patients.

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“…These pathophysiological disturbances may be the initial step in the development of portosystemic collateral circulation. 9,10 Detection and Classification of Portal Hypertension PH can be classified into three main categories based on the anatomic location of flow obstruction: prehepatic, intrahepatic, and posthepatic. Intrahepatic PH can be further subdivided into presinusoidal, sinusoidal, and postsinusoidal.…”

Section: Pathophysiologymentioning

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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Restructuring of the vascular bed in response to hemodynamic disturbances in portal hypertension

Cited by 11 publications

References 52 publications

P-Selectin Level at First and Third Day After Portal Hypertensive Splenectomy for Early Prediction of Portal Vein Thrombosis in Patients With Cirrhosis

P-Selectin Level at First and Third Day After Portal Hypertensive Splenectomy for Early Prediction of Portal Vein Thrombosis in Patients With Cirrhosis

Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis: An update and review of the literature

Surgical Portosystemic Shunts: History, Evolution, and Current Applications

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