Splenic Doppler impedance indices: Influence of different portal hemodynamic conditions

Bolognesi, Massimo; Sacerdoti, David; Merkel, Carlo; Gerunda, Giorgio Enrico; Maffei-Faccioli, A; Angeli, Paolo; Jemmolo, R. M.; Bombonato, Giancarlo; Gatta, Angelo

doi:10.1002/hep.510230515

Cited by 94 publications

(68 citation statements)

References 24 publications

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“…The causes of the increased spleen volume in cirrhosis are not clearly defined. Previous studies failed to establish a correlation between PP and splenomegaly,3, 6, 30, 31 although a direct correlation between spleen volume and portal vein diameter was reported 6. However, in our study, in which spleen volume was calculated in a more accurate way than just assessing the spleen diameter by ultrasonography and in which PP was carefully measured as the PPG, there was a significant correlation between spleen volume and baseline PPG.…”

Section: Discussionmentioning

confidence: 97%

Effects of splenic artery occlusion on portal pressure in patients with cirrhosis and portal hypertension

et al. 2006

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The specific contribution of splenic blood inflow to portal hypertension in patients with cirrhosis is still unclear. In this study, we investigated this contribution by assessing the hemodynamic effects of transient splenic artery occlusion. In 15 cirrhotic patients, portal pressure gradient (PPG) was measured just before inserting a transjugular intrahepatic portosystemic shunt (TIPS), in baseline conditions, for 15 minutes after splenic artery occlusion and 5 minutes after recovery. Splenic artery occlusion caused a significant decrease in PPG (range, Ϫ4% to Ϫ38%, median Ϫ20%, P Ͻ 0.001) which promptly returned to baseline values after recovery of the splenic inflow. The decrease in PPG showed a significant correlation with spleen volume (r ϭ 0.70, P Ͻ 0.005), liver volume (r ϭ Ϫ0.63; P Ͻ 0.01), and spleen/liver volume ratio (r ϭ 0.82, P Ͻ 0.001). Seven out of eight patients with a spleen/liver volume ratio greater than 0.5 had a marked decrease in PPG (Ͼ20%), whereas none of patients with a ratio lesser than 0.5 had a marked PPG response. In conclusion, in cirrhotic patients with portal hypertension, splenic artery occlusion causes a significant reduction in portal pressure (PPG). The drop in PPG is directly related to spleen volume and indirectly related to liver volume. The spleen/liver volume ratio accurately predicts the drop in PPG and may be used to identify patients who could obtain a significant advantage from surgical and nonsurgical procedures decreasing splenic inflow. See Editorial on Page 1186In patients with chronic liver disease, portal hypertension is induced by the hemodynamic interaction of abnormally high portal blood inflow and increased intrahepatic vascular resistance. 1 The splanchnic hyperemia is sustained mainly by splanchnic vasodilation, with increased mesenteric and splenic artery blood inflow. 2 Splenomegaly is a common finding in patients with cirrhosis and portal hypertension and is associated with increased splenic 3-5 and portal blood inflow. 6 The importance of the splenic blood inflow in the context of the splanchnic hyperemia is suggested by the observation that, in patients with cirrhosis, the contribution of splenic flow can increase portal blood flow by up to 60%. 7 Based on these observations, ligation of the splenic artery and splenectomy were proposed for the treatment of portal hypertension in patients with cirrhosis and recurrent episodes of hemorrhage from esophageal varices. [8][9][10][11][12][13][14] However, these nonshunting procedures caused only a mild reduction in portal pressure (PP) 9,10 which was suggested to be due to compensatory increases in mesenteric blood inflow. 7 After whole-organ liver transplantation, despite the normalization of intrahepatic resistance and PP, portal blood inflow remains elevated for months, which has Abbreviations: PPG, portal pressure gradient; PP, portal pressure; CT, computed tomography; NS, not significant. Address reprint requests to

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Section: Discussionmentioning

confidence: 97%

Effects of splenic artery occlusion on portal pressure in patients with cirrhosis and portal hypertension

et al. 2006

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“…Recipients and donors were examined by color Doppler ultrasound with a GE Logiq Book color Doppler ultrasound diagnostic apparatus with a 3.5‐MHz sector electronic probe preoperatively and on postoperative days (PODs) 1, 3, 5, 7, 30, and 90 after LDLT. Monitoring indices included the following: (1) PBV, which was measured as the mean of the maximal velocity of the portal vein multiplied by a coefficient of 0.57, and (2) PBF, which was obtained by multiplication of the portal vein cross‐sectional area by PBV under the assumption of a circular shape of the portal vein section, as previously reported 8, 9. All measurements were randomly performed by 1 of 2 operators.…”

Section: Methodsmentioning

confidence: 99%

Role of splanchnic hemodynamics in liver regeneration after living donor liver transplantation

et al. 2009

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The aim of this study was to investigate the changes in splanchnic hemodynamics after LDLT and their relationship with graft regeneration. Eighteen patients with LDLT December 2006 and June 2008 were enrolled, and color Doppler ultrasonography was performed preoperatively and on postoperative days (PODs) 1, 3, 5, 7, 30, and 90 after transplantation. The changes in the portal blood flow mean velocity (PBV) and portal blood flow volume (PBF) were monitored, and their effects on hepatic function were observed simultaneously. Graft sizes were measured on PODs 7, 30, and 90 after the operation. The regeneration rates of grafts were calculated. PBF increased in the recipient group from 1081.17 +/- 277.50 to 2171.44 +/- 613.15 mL/minute, and PBV increased from 15.01 +/- 5.67 to 56.00 +/- 22.11 cm/s; they were both significantly higher than those in the donor group (P < 0.01). On POD 1, serum aspartic aminotransferase, alanine aminotransferase, and total bilirubin all peaked; however, these indices in patients with PBF/graft weight (GW) > 300 mL/minute . 100 g were significantly higher than those in patients with PBF/GW < 300 mL/minute . 100 g. Livers in the recipient group regenerated rapidly. The graft regeneration rate reached 119.40% +/- 28.21% as early as 1 month post-transplantation. PBF and PBV on PODs 1 and 3 were greatly related to liver regeneration at 30 days. The portal venous flow in patients with portal hypertension after LDLT showed a high perfusion state, which could promote graft regeneration, but PBF/GW after the operation should be controlled below 300 mL/minute . 100 g in order to protect grafts from hyperperfusion injury.

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“…Interobserver and intraobserver variability of splanchnic echo‐Doppler measurements in our center has already been reported 12, 14, 17…”

Section: Methodsmentioning

confidence: 65%

“…Portal blood flow velocity (PBV) was evaluated as the time‐averaged maximum velocity multiplied by the coefficient 0.57, assuming the portal velocity profile to be parabolic, as previously reported 11, 12. Portal blood flow volume (PBF) was obtained by multiplication of the portal vein cross‐sectional area, assuming a circular shape of the portal vein section, by PBV 11, 12. The arterial Doppler resistance indices were measured as pulsatility index (PI) = (peak systolic velocity − end diastolic velocity)/mean velocity 13.…”

Section: Methodsmentioning

confidence: 99%

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Hepatitis C virus reinfection in liver transplant patients: Evaluation of liver damage progression with echo-color doppler

et al. 2008

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Liver transplant recipients are a model of rapid progression of hepatitis C virus (HCV)-related liver disease, from normal to cirrhosis. The aim of the study was the analysis of the relationship between portohepatic hemodynamics and modification in liver histology during the progression of HCV liver disease after transplant. Patients transplanted for HCV cirrhosis were considered for the study. At least every 6-12 months, the portal blood flow velocity, hepatic and splenic pulsatility indices, and a portal hypertensive index (obtained from the combination of the portal blood velocity and splenic pulsatility index) were measured with echo-Doppler. Liver biopsy was performed whenever necessary. The time course of echo-Doppler parameters during the histological progression of the liver disease was analyzed. Posttransplant patients without HCV were included as controls. Forty-nine patients with histology-proven relapse of HCV hepatitis were included in the study. At the onset of recurrent hepatitis, the portal blood flow velocity significantly decreased (P Ͻ 0.001), and the splenic pulsatility index increased (P ϭ 0.020), whereas the hepatic pulsatility index remained unchanged. In the following years, in addition to a further slight decrease in the portal blood velocity (P ϭ 0.027), a progressive increase in the hepatic and splenic pulsatility indices was also detected (P ϭ 0.009 and P Ͻ 0.0001, respectively). The portal hypertensive index steadily increased with the progression of the disease and was related to the degree of liver fibrosis. In conclusion, the information obtainable from splanchnic Doppler parameters can be used to monitor the progression of liver fibrosis in transplant patients with HCV reinfection. Liver Transpl 14: 616-624, 2008.

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Splenic Doppler impedance indices: Influence of different portal hemodynamic conditions

Cited by 94 publications

References 24 publications

Effects of splenic artery occlusion on portal pressure in patients with cirrhosis and portal hypertension

Effects of splenic artery occlusion on portal pressure in patients with cirrhosis and portal hypertension

Role of splanchnic hemodynamics in liver regeneration after living donor liver transplantation

Hepatitis C virus reinfection in liver transplant patients: Evaluation of liver damage progression with echo-color doppler

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