-
Radiology Research and Practice 2015Congenital extrahepatic portosystemic shunt (CEPS) is a rare disorder characterised by partial or complete diversion of portomesenteric blood into systemic veins via... (Review)
Review
Congenital extrahepatic portosystemic shunt (CEPS) is a rare disorder characterised by partial or complete diversion of portomesenteric blood into systemic veins via congenital shunts. Type I is characterised by complete lack of intrahepatic portal venous blood flow due to an end to side fistula between main portal vein and the inferior vena cava. Type II on the other hand is characterised by partial preservation of portal blood supply to liver and side to side fistula between main portal vein or its branches and mesenteric, splenic, gastric, and systemic veins. The presentation of these patients is variable. Focal liver lesions, most commonly nodular regenerative hyperplasia, are an important clue to the underlying condition. This pictorial essay covers imaging characteristics in abdominopelvic region.
PubMed: 26858845
DOI: 10.1155/2015/181958 -
World Journal of Gastroenterology Jun 2020Portal vein thrombosis (PVT) is currently not considered a contraindication for liver transplantation (LT), but diffuse or complicated PVT remains a major surgical... (Review)
Review
Portal vein thrombosis (PVT) is currently not considered a contraindication for liver transplantation (LT), but diffuse or complicated PVT remains a major surgical challenge. Here, we review the prevalence, natural course and current grading systems of PVT and propose a tailored classification of PVT in the setting of LT. PVT in liver transplant recipients is classified into three types, corresponding to three portal reconstruction strategies: Anatomical, physiological and non-physiological. Type I PVT can be removed low dissection of the portal vein (PV) or thrombectomy; porto-portal anastomosis is then performed with or without an interposed vascular graft. Physiological reconstruction used for type II PVT includes vascular interposition between mesenteric veins and PV, collateral-PV and splenic vein-PV anastomosis. Non-physiological reconstruction used for type III PVT includes cavoportal hemitransposition, renoportal anastomosis, portal vein arterialization and multivisceral transplantation. All portal reconstruction techniques were reviewed. This tailored classification system stratifies PVT patients by surgical complexity, risk of postoperative complications and long-term survival. We advocate using the tailored classification for PVT grading before LT, which will urge transplant surgeons to make a better preoperative planning and pay more attention to all potential strategies for portal reconstruction. Further verification in a large-sample cohort study is needed.
Topics: Allografts; Anastomosis, Surgical; Dissection; Humans; Liver; Liver Transplantation; Patient Care Planning; Portal Vein; Postoperative Complications; Preoperative Period; Prevalence; Thrombectomy; Venous Thrombosis
PubMed: 32550747
DOI: 10.3748/wjg.v26.i21.2691 -
International Journal of Clinical and... 2014To investigate the changes and contributions of superior mesenteric venous perfusion (SMVP) and splenic venous perfusion (SpVP) to portal venous CT perfusion in canine...
AIM
To investigate the changes and contributions of superior mesenteric venous perfusion (SMVP) and splenic venous perfusion (SpVP) to portal venous CT perfusion in canine model of hepatic diffuse disease.
MATERIALS AND METHODS
By selective catheterization in superior mesenteric and splenic arteries respectively after CT perfusion scanning, SMVP and SpVP became available. Sixteen dogs were adopted and induced by carbon tetrachloride after data under normal conditions were collected. After 3, 6, 9 and 12 months from carbon tetrachloride intervention, liver biopsies by puncture or operation were performed after CT perfusion scanning. SMVP and SpVP under different pathologic conditions were compared and analyzed.
RESULTS
Three stages of hepatic diffuse lesions were defined according to pathologic changes, namely hepatitis, hepatic fibrosis, and cirrhosis. The number of dogs which survived from each stage was: 16 from normal, 12 from hepatitis, 10 from hepatic fibrosis and 4 from cirrhosis. During this progressive period, SpVP ml/(min·100 ml) declined slightly, but there were no significant differences between different stages (P > 0.05). SMVP ml/(min·100 ml) in stage of normal (64.1 ± 8.1) and hepatic fibrosis (44.4 ± 4.5), normal and cirrhosis (42.6 ± 5.4), hepatitis (61.3 ± 6.4) and hepatic fibrosis, hepatitis and cirrhosis was significantly different, but there was no significant difference of SMVP between normal and hepatitis (P = 0.326) or hepatic fibrosis and cirrhosis (P = 0.668).
CONCLUSIONS
With our evidence of interventional CT perfusion, it is mesenteric, not splenic, perfusion that might coincide with hepatic portal venous perfusion during the progressive period of hepatic diffuse disease.
Topics: Animals; Carbon Tetrachloride; Disease Models, Animal; Dogs; Hepatitis, Animal; Liver Cirrhosis; Mesenteric Veins; Radiography; Splenic Vein
PubMed: 25550855
DOI: No ID Found -
Revista Espanola de Enfermedades... Feb 2023Portal hypertension, responsible for the formation of oesophageal varices, also generates intra-abdominal varicose dilations, especially of the perisplenic and...
Portal hypertension, responsible for the formation of oesophageal varices, also generates intra-abdominal varicose dilations, especially of the perisplenic and mesenteric veins, which, like the oesophageal veins, are susceptible to rupturing and bleeding, in this case within the peritoneal cavity. However, the spontaneous rupture of these intraperitoneal varices is a rare complication, and poorly described in the literature. We present the case of a 72-year-old woman with CHILD B liver cirrhosis of unknown aetiology with portal hypertension on primary prophylaxis with carvedilol.
Topics: Female; Humans; Aged; Hemoperitoneum; Liver Cirrhosis, Alcoholic; Varicose Veins; Liver Cirrhosis; Esophageal and Gastric Varices; Rupture, Spontaneous; Hypertension, Portal
PubMed: 35748469
DOI: 10.17235/reed.2022.8937/2022 -
The Korean Journal of Gastroenterology... Jul 2023Phlebosclerotic colitis is a rare form of intestinal ischemia. It is caused by calcified peripheral mesenteric veins and a thickened colonic wall. These characteristic... (Review)
Review
Phlebosclerotic colitis is a rare form of intestinal ischemia. It is caused by calcified peripheral mesenteric veins and a thickened colonic wall. These characteristic findings can be identified on CT and colonoscopy. A 37-year-old female with a history of long-term herbal medicine use presented with acute lower abdominal pain and vomiting of sudden onset. Colonoscopic findings showed dark-blue discolored edematous mucosa and multiple ulcers from the ascending colon to the sigmoid colon. Abdominal CT findings showed diffuse thickening of the colonic wall and calcifications of the peripheral mesenteric veins from the ascending colon to the sigmoid colon. Based on these findings, the patient was diagnosed with phlebosclerotic colitis. We report this rare case of phlebosclerotic colitis in a healthy young female patient with a history of long-term herbal medicine use and include a review of the relevant literature.
Topics: Adult; Female; Humans; Colitis; Colitis, Ischemic; Colonoscopy; Plant Extracts; Tomography, X-Ray Computed
PubMed: 37489080
DOI: 10.4166/kjg.2023.058 -
International Journal of Surgery... Oct 2020Nontumoral portal vein thrombosis (PVT) is present at liver transplantation (LT) in 5-26% of cirrhotic patients, and is known to affect post LT outcomes. Up to 31% of... (Review)
Review
Nontumoral portal vein thrombosis (PVT) is present at liver transplantation (LT) in 5-26% of cirrhotic patients, and is known to affect post LT outcomes. Up to 31% of patients who are found to have PVT at the time of LT, would have had PVT at the time of initial listing, but others develop PVT during the waiting period. Adequate screening and treatment of the PVT on the waiting list for LT is thus essential so that a portoportal anastomoses can be performed at the time of LT. Early PVT (Yerdel Grade I/II) can be usually managed by thrombectomy, whereas Grade III PVT may require a jump graft from the superior mesenteric vein to the graft PV. Complete portomesenteric thrombosis is a huge challenge, and sometimes a cause for denying a LT in these patients, with multivisceral transplant being the only alternative. The presence of spontaneous, or previously surgically created portosytemic shunts like the leinorenal shunt, may serve as a good inflow option (renoportal anastomosis) in these patients to establish a physiological reconstruction. Although challenging, good outcomes are possible in patients with complex PVT if the appropriate surgical technique is chosen to ensure portal inflow and resolution of PHT post LT.
Topics: Female; Humans; Liver Cirrhosis; Liver Transplantation; Male; Mesenteric Veins; Middle Aged; Portal Vein; Thrombectomy; Vascular Surgical Procedures; Venous Thrombosis; Waiting Lists
PubMed: 32387201
DOI: 10.1016/j.ijsu.2020.04.068 -
International Journal of Surgery Case... Mar 2022An arteriovenous malformation (AVM) is defined as a vascular malformation with a short, non-capillary communication between the arteries and veins. Most gastrointestinal...
INTRODUCTION AND IMPORTANCE
An arteriovenous malformation (AVM) is defined as a vascular malformation with a short, non-capillary communication between the arteries and veins. Most gastrointestinal AVMs are solitary, occurring predominantly in the stomach, small intestine and right colon, and rarely in the inferior mesenteric artery (IMA) region.
CASE PRESENTATION
A 70-year-old man was first diagnosed with ischemic enteritis two years earlier, and was hospitalized several times with the same diagnosis. He visited our hospital because of left lower abdominal pain and melena. Colonoscopy showed findings suggestive of ischemic enteritis, and contrast-enhanced computed tomography (CT) and IMA angiography showed hyperplasia and dilation of blood vessels from the sigmoid-descending colon junction to the upper rectum. We performed conventional laparoscopic low anterior resection using intraoperative intravenous injection of indocyanine green (ICG). The final diagnosis was arteriovenous malformation in the IMA region. The patient had an uneventful postoperative course and was discharged on the 13th day after the operation.
CLINICAL DISCUSSION
Cases of AVM in the IMA region are relatively rare. This is the first reported case of AVM in the IMA region that was resected under intraoperative ICG fluorescence imaging (FI), which provided useful information on the extent of intestinal resection and mesenteric dissection required, and confirmed the adequacy of intestinal blood flow during and after mesenteric dissection and anastomosis.
CONCLUSION
It is advisable to use ICG FI intraoperatively during resection of AVMs in the IMA region, as with colorectal cancer surgery.
PubMed: 35176584
DOI: 10.1016/j.ijscr.2022.106831 -
Journal of Vascular Research 2021Studies in Cx40-GCaMP2 mice, which express calcium biosensor GCaMP2 in the endothelium under connexin 40 promoter, have identified the unique properties of endothelial... (Comparative Study)
Comparative Study
INTRODUCTION
Studies in Cx40-GCaMP2 mice, which express calcium biosensor GCaMP2 in the endothelium under connexin 40 promoter, have identified the unique properties of endothelial calcium signals. However, Cx40-GCaMP2 mouse is associated with a narrow dynamic range and lack of signal in the venous endothelium. Recent studies have proposed many GCaMPs (GCaMP5/6/7/8) with improved properties although their performance in endothelium-specific calcium studies is not known.
METHODS
We characterized a newly developed mouse line that constitutively expresses GCaMP8 in the endothelium under the VE-cadherin (Cdh5-GCaMP8) promoter. Calcium signals through endothelial IP3 receptors and TRP vanilloid 4 (TRPV4) ion channels were recorded in mesenteric arteries (MAs) and veins from Cdh5-GCaMP8 and Cx40-GCaMP2 mice.
RESULTS
Cdh5-GCaMP8 mice showed lower baseline fluorescence intensity, higher dynamic range, and higher amplitudes of individual calcium signals than Cx40-GCaMP2 mice. Importantly, Cdh5-GCaMP8 mice enabled the first recordings of discrete calcium signals in the intact venous endothelium and revealed striking differences in IP3 receptor and TRPV4 channel calcium signals between MAs and mesenteric veins.
CONCLUSION
Our findings suggest that Cdh5-GCaMP8 mice represent significant improvements in dynamic range, sensitivity for low-intensity signals, and the ability to record calcium signals in venous endothelium.
Topics: Animals; Antigens, CD; Biosensing Techniques; Cadherins; Calcium; Calcium Signaling; Calcium-Binding Proteins; Connexins; Endothelial Cells; Green Fluorescent Proteins; Inositol 1,4,5-Trisphosphate Receptors; Mesenteric Arteries; Mesenteric Veins; Mice, Inbred C57BL; Mice, Transgenic; Microscopy, Fluorescence; Promoter Regions, Genetic; TRPV Cation Channels; Gap Junction alpha-5 Protein; Mice
PubMed: 33706307
DOI: 10.1159/000514210 -
World Journal of Gastroenterology Jun 2023Splenic vein thrombosis is a known complication of pancreatitis. It can lead to increased blood flow through mesenteric collaterals. This segmental hypertension may... (Review)
Review
BACKGROUND
Splenic vein thrombosis is a known complication of pancreatitis. It can lead to increased blood flow through mesenteric collaterals. This segmental hypertension may result in the development of colonic varices (CV) with a high risk of severe gastrointestinal bleeding. While clear guidelines for treatment are lacking, splenectomy or splenic artery embolization are often used to treat bleeding. Splenic vein stenting has been shown to be a safe option.
CASE SUMMARY
A 45-year-old female patient was admitted due to recurrent gastrointestinal bleeding. She was anemic with a hemoglobin of 8.0 g/dL. As a source of bleeding, CV were identified. Computed tomography scans revealed thrombotic occlusion of the splenic vein, presumably as a result of a severe acute pancreatitis 8 years prior. In a selective angiography, a dilated mesenterial collateral leading from the spleen to enlarged vessels in the right colonic flexure and draining into the superior mesenteric vein could be confirmed. The hepatic venous pressure gradient was within normal range. In an interdisciplinary board, transhepatic recanalization of the splenic vein balloon dilatation and consecutive stenting, as well as coiling of the aberrant veins was discussed and successfully performed. Consecutive evaluation revealed complete regression of CV and splenomegaly as well as normalization of the red blood cell count during follow-up.
CONCLUSION
Recanalization and stenting of splenic vein thrombosis might be considered in patients with gastrointestinal bleeding due to CV. However, a multidisciplinary approach with a thorough workup and discussion of individualized therapeutic strategies is crucial in these difficult to treat patients.
Topics: Female; Humans; Middle Aged; Acute Disease; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Pancreatitis; Portal Vein; Splenic Diseases; Splenic Vein; Varicose Veins; Venous Thrombosis; Tomography, X-Ray Computed
PubMed: 37426315
DOI: 10.3748/wjg.v29.i24.3922 -
American Journal of Physiology.... Mar 2015Lymphangions, the segments of lymphatic vessels between two adjacent lymphatic valves, actively pump lymph. Acute changes in transmural pressure and lymph flow have...
Lymphangions, the segments of lymphatic vessels between two adjacent lymphatic valves, actively pump lymph. Acute changes in transmural pressure and lymph flow have profound effects on lymphatic pump function in vitro. Chronic changes in pressure and flow in vivo have also been reported to lead to significant changes in lymphangion function. Because changes in pressure and flow are both cause and effect of adaptive processes, characterizing adaptation requires a more fundamental analysis of lymphatic muscle properties. Therefore, the purpose of the present work was to use an intact lymphangion isovolumetric preparation to evaluate changes in mesenteric lymphatic muscle mechanical properties and the intracellular Ca(2+) in response to sustained mesenteric venous hypertension. Bovine mesenteric veins were surgically occluded to create mesenteric venous hypertension. Postnodal mesenteric lymphatic vessels from mesenteric venous hypertension (MVH; n = 6) and sham surgery (Sham; n = 6) animals were isolated and evaluated 3 days after the surgery. Spontaneously contracting MVH vessels generated end-systolic active tension and end-diastolic active tension lower than the Sham vessels. Furthermore, steady-state active tension and intracellular Ca(2+) concentration levels in response to KCl stimulation were also significantly lower in MVH vessels compared with those of the Sham vessels. There was no significant difference in passive tension in lymphatic vessels from the two groups. Taken together, these results suggest that following 3 days of mesenteric venous hypertension, postnodal mesenteric lymphatic vessels adapt to become weaker pumps with decreased cytosolic Ca(2+) concentration.
Topics: Adaptation, Physiological; Animals; Biological Transport, Active; Calcium; Cattle; Disease Models, Animal; Female; Lymph; Lymphatic Vessels; Mesenteric Veins; Muscle Contraction; Muscle, Smooth; Pressure; Time Factors; Venous Pressure
PubMed: 25519727
DOI: 10.1152/ajpregu.00196.2014