Short-Term Hemodynamic Effects of Transjugular Retrograde Obliteration of Gastric Varices with Gastrorenal Shunt

Abstract

Objectives: The purpose of this study was to investigate the short-term effects on portal hemodynamics of transjugular retrograde obliteration (TJO) of gastric varices with gastrorenal shunt. Methods: Thirty patients with gastric varices and a gastrorenal shunt were included in this study. The patients ranged in age from 42 to 75 years (16 men and 14 women), and according to Child’s classification, class A, B and C cirrhosis was seen in 1, 13 and 16 patients, respectively. The portal blood flow was measured by an ultrasonic duplex Doppler system, and the wedged hepatic venous pressure was measured by hepatic venous catheterization, before and after TJO. Results: Complete obliteration of the gastrorenal shunt and gastric varices was revealed by retrograde inferior phrenic venography and computed tomography after TJO in all cases. The wedged hepatic venous pressure was significantly increased the day after TJO compared with that before therapy (257 ± 71 vs. 307 ± 73 mm H₂O, p < 0.01). The portal venous flow was significantly increased 1 week after TJO compared with that before therapy (744 ± 190 vs. 946 ± 166 ml/min, p < 0.01). The serum albumin levels before and after TJO were 3.0 ± 0.4 and 3.1 ± 0.5 g/dl, respectively, and the total bilirubin levels were 1.5 ± 0.7 and 1.5 ± 0.8 mg/dl, respectively, neither of these parameters changing significantly. The plasma ammonia levels before and after TJO were 109 ± 62 and 67 ± 31 μg/dl, and the indocyanine green retention rates at 15 min were 31 ± 13 and 24 ± 13%, both showing a significant change (p < 0.01 and p < 0.05, respectively). Conclusions: We conclude that TJO increases portal blood flow which contributes to the decrease in plasma ammonia levels and the indocyanine green retention rate, although increasing the wedged hepatic venous pressure.

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

“…7 However, this study indicated that NH 3 did not change after the combined therapy in the long term. We believe that the increase of superior mesenteric venous flow compensates for the decrease of splenic venous flow, and newly developed collaterals, except the splenorenal shunt, restore NH 3 in the long term.…”

“…1,7,8 After selective splenic arteriography, >50% embolization was performed using a platinum microcoil and/or a stainless steel coil. TJO was performed 2 weeks after PSE.…”

Vascular Plug-Assisted Retrograde Transvenous Obliteration for the Management of Gastric Varices: Comparative Effectiveness between Gelatin Sponge Embolization and Permanent Sclerosant

“…(25,26). In fact, several factors influence the incidence of both, such as a high Child-Pugh class, concomitant existence of another disease such as hepatocellular carcinoma, and hypoalbuminemia.…”

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

“…We previously reported that a combined therapy, using partial splenic embolization and TJO, is an effective treatment for GV with SRS from the portal hemodynamic point of view [13,20]. TJO can improve NH 3 , but TJO increases WHVP [21]. Partial splenic embolization can reduce the SVF and WHVP [22].…”