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Clinical implications of portal hemodynamics after small-diameter portacaval H graft

Journal Article · · Surgery; (United States)
OSTI ID:6477871
; ; ; ; ;
To assess the role of portal hemodynamics in the development of postshunt encephalopathy, we studied 19 patients after small-diameter portacaval H grafting (SD-PCHG). We used contrast studies as well as technetium-labeled macroaggregated albumin injected into the portal vein to assess direction of portal flow. We then quantitated the mesenteric fraction of flow perfusing the liver by injecting macroaggregated albumin into a peripheral mesenteric vein tributary. We found that none of seven patients with prograde flow by both scintigraphy and angiography developed postoperative encephalopathy, but the incidence was 58% in the remaining patients (p . 0.02). The fraction of mesenteric flow perfusing the liver after SD-PCHG was 12% +/- 4%, but this did not significantly correlate with encephalopathy rates. We conclude that after SD-PCHG, prograde portal flow minimizes encephalopathy rates. Although encephalopathy occurs in patients with predominantly reversed flow, a subgroup of patients with reversed flow remain without symptoms. The absolute fraction of mesenteric flow perfusing the liver has less influence on encephalopathy rates than has direction of portal flow. This study identifies a complex relationship between portal hemodynamics and encephalopathy.
Research Organization:
Department of Surgery, Long Beach Veterans Administration Medical Center, California
OSTI ID:
6477871
Journal Information:
Surgery; (United States), Journal Name: Surgery; (United States) Vol. 96:2; ISSN SURGA
Country of Publication:
United States
Language:
English

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Related Subjects

551001* -- Physiological Systems-- Tracer Techniques
59 BASIC BIOLOGICAL SCIENCES
BETA DECAY RADIOISOTOPES
BETA-MINUS DECAY RADIOISOTOPES
BLOOD FLOW
BLOOD VESSELS
BODY
BRAIN
CARDIOVASCULAR SYSTEM
CENTRAL NERVOUS SYSTEM
CORRELATIONS
DIGESTIVE SYSTEM
GLANDS
GRAFTS
HOURS LIVING RADIOISOTOPES
INTERMEDIATE MASS NUCLEI
ISOMERIC TRANSITION ISOTOPES
ISOTOPE APPLICATIONS
ISOTOPES
LIVER
NERVOUS SYSTEM
NUCLEI
ODD-EVEN NUCLEI
ORGANS
PATHOLOGICAL CHANGES
PORTAL SYSTEM
RADIOISOTOPES
TECHNETIUM 99
TECHNETIUM ISOTOPES
TRACER TECHNIQUES
TRANSPLANTS
VEINS
YEARS LIVING RADIOISOTOPES