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Journal of Gastrointestinal Surgery :... Mar 2024This systematic review and meta-analysis aimed to assess the efficacy and safety of transjugular intrahepatic portosystemic shunts (TIPS) against the combined treatment... (Meta-Analysis)
Meta-Analysis Review
Safety and efficacy of transjugular intrahepatic portosystemic shunts vs endoscopic band ligation plus propranolol in patients with cirrhosis with portal vein thrombosis: a systematic review and meta-analysis.
BACKGROUND
This systematic review and meta-analysis aimed to assess the efficacy and safety of transjugular intrahepatic portosystemic shunts (TIPS) against the combined treatment of endoscopic band ligation (EBL) and propranolol in managing patients with cirrhosis diagnosed with portal vein thrombosis (PVT).
METHODS
A literature search from inception to September 2023 was performed using MEDLINE, the Cochrane Library, Web of Science, and Scopus. Independent screening, data extraction, and quality assessment were performed. The main measured outcomes were the incidence and recurrence of variceal bleeding (VB), hepatic encephalopathy, and overall survival.
RESULTS
A total of 5 studies were included. For variceal eradication, there was initially no significant difference between the groups; however, after sensitivity analysis, a significant effect emerged (risk ratio [RR], 1.55; P < .0001). TIPS was associated with a significant decrease in the incidence of VB (RR, 0.34; P < .0001) and a higher probability of remaining free of VB in the first 2 years after the procedure (first year: RR, 1.41; P < .0001; second year: RR, 1.58; P < .0001). TIPS significantly reduced the incidence of death due to acute GI bleeding compared with EBL + propranolol (RR, 0.37; P = .05).
CONCLUSION
TIPS offers a comprehensive therapeutic advantage over the combined EBL and propranolol regimen, especially for patients with cirrhosis with PVT. Its efficacy in variceal eradication, reducing rebleeding, and mitigating death risks due to acute GI bleeding is evident.
Topics: Humans; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Liver Cirrhosis; Liver Diseases; Portal Vein; Portasystemic Shunt, Transjugular Intrahepatic; Propranolol; Thrombosis
PubMed: 38445926
DOI: 10.1016/j.gassur.2023.12.031 -
Seminars in Interventional Radiology Jun 2023The addition of hepatic venous embolization to portal venous embolization to achieve ipsilateral liver venous deprivation before major hepatectomy has been suggested to... (Review)
Review
The addition of hepatic venous embolization to portal venous embolization to achieve ipsilateral liver venous deprivation before major hepatectomy has been suggested to increase the extent of hypertrophy of the future liver remnant. The presented case discusses a hepatic vein embolization procedure complicated by the unintended migration of a glue cast used to achieve hepatic venous occlusion and subsequent management with endovascular retrieval of the glue cast from the inferior vena cava. The emerging role of hepatic venous embolization and associated complications are also discussed.
PubMed: 37484445
DOI: 10.1055/s-0043-1769773 -
Arquivos Brasileiros de Cirurgia... 2023Hepatosplenic schistosomiasis is an endemic disease prevalent in tropical countries and is associated with a high incidence of portal vein thrombosis. Inflammatory...
BACKGROUND
Hepatosplenic schistosomiasis is an endemic disease prevalent in tropical countries and is associated with a high incidence of portal vein thrombosis. Inflammatory changes caused by both parasitic infection and portal thrombosis can lead to the development of chronic liver disease with potential carcinogenesis.
AIMS
To assess the incidence of portal vein thrombosis and hepatocellular carcinoma in patients with schistosomiasis during long-term follow-up.
METHODS
A retrospective study was conducted involving patients with schistosomiasis followed up at our institution between 1990 and 2021.
RESULTS
A total of 126 patients with schistosomiasis were evaluated in the study. The mean follow-up time was 16 years (range 5-31). Of the total, 73 (57.9%) patients presented portal vein thrombosis during follow-up. Six (8.1%) of them were diagnosed with hepatocellular carcinoma, all with portal vein thrombosis diagnosed more than ten years before.
CONCLUSIONS
The incidence of hepatocellular carcinoma in patients with schistosomiasis and chronic portal vein thrombosis highlights the importance of a systematic long-term follow-up in this group of patients.
Topics: Humans; Carcinoma, Hepatocellular; Portal Vein; Retrospective Studies; Liver Neoplasms; Risk Factors; Schistosomiasis; Thrombosis
PubMed: 37729278
DOI: 10.1590/0102-672020230045e1763 -
Medical Physics Oct 2023It was still controversial that whether the increase of splenic vein (SV) diameter increased the risk of portal vein thrombosis (PVT), which was a severe disease with...
BACKGROUND
It was still controversial that whether the increase of splenic vein (SV) diameter increased the risk of portal vein thrombosis (PVT), which was a severe disease with high mortality, in the clinic.
PURPOSES
This study, using computational fluid dynamics method, aimed to investigate how the increase of SV diameter affects the portal vein hemodynamics under different anatomical and geometric features of the portal venous system, thus how it induced to PVT.
METHODS
The ideal models of the portal system, including different anatomical structures according to the location of left gastric vein (LGV) and inferior mesenteric vein (IMV), and different geometric morphological parameters models were established to carry out numerical simulation in this study. In addition, the morphological parameters of real patients were measured to verify the numerical simulation results.
RESULTS
First, the wall shear stress (WSS) and helicity intensity, which were closely related to the occurrence of thrombosis, gradually decreased with the increase of SV diameter in all models. However, the degree of decrease was bigger in following models: (1) the models with LGV and IMV linking to SV compared with them linking to PV; (2) the models with big angle of PV and SV compared with small angle. In addition, the morbidity of PVT was higher when LGV and IMV linked to SV rather than them linked to PV in the real patients. Moreover, the angle of PV and SV was also different between PVT and non-PVT patients (125.53° ± 16.90° vs. 115.03° ± 16.10°, p = 0.01).
CONCLUSION
Whether the increase of SV diameter will result in PVT is depended on the anatomical structure of portal system and the angle between PV and SV, this is also the reason leading to the clinical controversy that the increase of SV diameter is the risk factor of PVT.
Topics: Humans; Portal Vein; Splenic Vein; Venous Thrombosis; Liver Cirrhosis; Thrombosis; Retrospective Studies
PubMed: 37227701
DOI: 10.1002/mp.16481 -
Asian Pacific Journal of Cancer... Dec 2023Angiogenesis contributes to hepatocellular carcinoma (HCC) progression by promoting tumor growth and metastasis. Netrin-4 (NTN4) is a secreted glycoprotein that has been...
BACKGROUND
Angiogenesis contributes to hepatocellular carcinoma (HCC) progression by promoting tumor growth and metastasis. Netrin-4 (NTN4) is a secreted glycoprotein that has been reported to control angiogenesis and preserve endothelial homeostasis. Macrovascular invasion of the portal vein, referred to as portal vein invasion (PVI) is associated with poor prognosis in HCC patients. In this work, we sought to understand more about the systemic and hepatic level expression of NTN4 and its receptors in HCC patients with and without portal vein invasion.
METHODS
A total of 154 patients with HCC, and 90 healthy volunteers were recruited in this case-control study. Patients with HCC were further subdivided into those with portal vein invasion (PVI) (n=68), and those without portal vein invasion (NPVI) (n=86). Clinical characteristics and liver function parameters were recorded among the study subjects PVI and NPVI. The serum levels of NTN4 (pg/ml) were estimated by ELISA. HCC tissues and normal non-tumorous liver tissues (controls) were collected for gene expression analysis of NTN4 and its receptors.
RESULTS
ALT, ALP, and GGT levels were significantly elevated in the serum of HCC patients with PVI compared to NPVI and control subjects. Systemic NTN4 was significantly reduced in both PVI and NPVI patients compared to control subjects. At the tissue level, the hepatic NTN4 followed a similar trend with significantly lower mRNA expression in both patients with PVI and NPVI compared to control subjects.
CONCLUSIONS
Systemic and hepatic NTN4 levels were reduced in both PVI and NPVI subjects. The hepatic expression of NTN4 receptors Neogenin and UNC5B were markedly elevated in patients with HCC with PVI compared to NPVI. Future experimental studies might shed the role of NTN4 and its receptors in the development of PVI in HCC.
Topics: Humans; Carcinoma, Hepatocellular; Case-Control Studies; Liver Neoplasms; Neoplasm Invasiveness; Netrin Receptors; Netrins; Portal Vein
PubMed: 38156865
DOI: 10.31557/APJCP.2023.24.12.4285 -
Interventional Radiology... Mar 2024Preoperative portal vein embolization is a beneficial option to reduce the risk of postoperative liver failure by promoting the growth of the future liver remnant. In... (Review)
Review
Preoperative portal vein embolization is a beneficial option to reduce the risk of postoperative liver failure by promoting the growth of the future liver remnant. In particular, a percutaneous transhepatic procedure (percutaneous transhepatic portal vein embolization) has been developed as a less-invasive approach. Although percutaneous transhepatic portal vein embolization is widely recognized as a safe procedure, various complications, including rare but fatal adverse events, have been reported. Currently, there are no prospective clinical trials regarding percutaneous transhepatic portal vein embolization procedures and no standard guidelines for the PTPE procedure in Japan. As a result, various methods and various embolic materials are used in each hospital according to each physician's policy. The purpose of these guidelines is to propose appropriate techniques at present and to identify issues that should be addressed in the future for safer and more reliable percutaneous transhepatic portal vein embolization techniques.
PubMed: 38525000
DOI: 10.22575/interventionalradiology.2022-0031 -
IEEE Transactions on Bio-medical... Jan 2024The acquisition of real-time portal vein pressure (PVP) is important for portal hypertension (PH) discrimination to monitor disease progress and select treatment...
OBJECTIVE
The acquisition of real-time portal vein pressure (PVP) is important for portal hypertension (PH) discrimination to monitor disease progress and select treatment options. To date, the PVP evaluation approaches are either invasive or noninvasive but with less stability and sensitivity.
METHODS
We customized an open ultrasound scanner to explore in vitro and in vivo the ultrasound contrast agent SonoVue microbubbles' subharmonic characteristics with acoustic pressure and local ambient pressure, and obtained promising results of PVP measurements in canine models with induced PH by ligation or embolization of portal vein.
RESULTS
In in vitro experiments, the highest correlations between the subharmonic amplitude of SonoVue microbubbles and ambient pressure were observed at acoustic pressures of 523 kPa and 563 kPa (r = -0.993, -0.993, P<0.05, respectively). The correlation coefficients between absolute subharmonic amplitudes and PVP (10.7-35.4 mmHg) were the highest among existing studies using microbubbles as pressure sensors (r values ranged from -0.819 to -0.918). The PH (>16 mmHg) diagnostic capacity also achieved a high level (563 kPa, sensitivity = 93.3%, specificity = 91.7%, accuracy = 92.6%).
CONCLUSION
This study proposes a promising measurement for PVP with the highest accuracy, sensitivity, and specificity in an in vivo model compared to existing studies. Future investigations are planned to assess the feasibility of this technique in clinical practice.
SIGNIFICANCE
This is the first study that comprehensively investigates the role of the subharmonic scattering signals from SonoVue microbubbles in evaluating PVP in vivo. It represents a promising alternative to invasive measurements for portal pressure.
Topics: Animals; Dogs; Contrast Media; Portal Vein; Microbubbles; Portal Pressure; Ultrasonography; Hypertension, Portal
PubMed: 37432834
DOI: 10.1109/TBME.2023.3293952 -
European Radiology Nov 2023To identify prognostic CT features that predict recurrence in patients with resectable pancreatic body/tail adenocarcinoma (PBTA) and construct a CT-based nomogram for...
OBJECTIVES
To identify prognostic CT features that predict recurrence in patients with resectable pancreatic body/tail adenocarcinoma (PBTA) and construct a CT-based nomogram for preoperative risk stratification.
METHODS
A total of 258 patients with resectable PBTA who underwent upfront surgery were retrospectively enrolled (development cohort, n = 172; validation cohort, n = 86), and their clinical and CT features were analyzed. Stepwise Cox proportional hazard analysis was performed to identify prognostic features and construct a predictive nomogram for recurrence-free survival (RFS). The prognostic performance of the CT-based nomogram was validated and compared to the 8 American Joint Committee on Cancer (AJCC) pathological staging system.
RESULTS
In the development cohort, the following five CT features for predicting recurrence were identified to construct the nomogram: tumor density in the venous phase, tumor necrosis, adjacent organ invasion, splenic vein invasion, and superior mesenteric vein/portal vein abutment. In the validation cohort, the CT-based nomogram showed a concordance index of 0.65 (95% confidence interval: 0.58-0.73), which was higher than the 8 AJCC staging system. The area under the curves of the nomogram for predicting recurrence at 0.5, 1, and 2 years were 0.66, 0.71, and 0.72, respectively. Patients were categorized into high- and low-risk groups with 1-year recurrence probabilities of 0.73 and 0.43, respectively.
CONCLUSIONS
The proposed nomogram provided accurate recurrence risk stratification for patients with resectable PBTA in a preoperative setting and may be used to facilitate clinical decision-making.
CLINICAL RELEVANCE STATEMENT
The proposed CT-based nomogram, based on easily available CT features, may serve as an effective and convenient tool for stratifying further the recurrence risk of patients with pancreatic body/tail adenocarcinoma.
KEY POINTS
• The CT-based nomogram, incorporating five commonly used CT features, successfully preoperatively stratified patients with resectable PBTA into distinct prognosis groups. • Tumor density in the venous phase, tumor necrosis, splenic vein invasion, adjacent organ invasion, and superior mesenteric vein/portal vein abutment were associated with RFS in patients with resectable PBTA. • The CT-based nomogram exhibited better predictive performance for recurrence than the 8 AJCC staging system.
Topics: Humans; Nomograms; Retrospective Studies; Adenocarcinoma; Prognosis; Portal Vein; Risk Assessment; Tomography, X-Ray Computed; Necrosis; Pancreatic Neoplasms
PubMed: 37624415
DOI: 10.1007/s00330-023-10047-x -
Indian Journal of Pediatrics Mar 2024Chronic liver disease (CLD) in children is more diverse compared to adults with respect to the etiology, progression and response to therapy. After history and clinical... (Review)
Review
Chronic liver disease (CLD) in children is more diverse compared to adults with respect to the etiology, progression and response to therapy. After history and clinical examination, the first step is to confirm the presence of CLD with basic blood investigations and ultrasonography. Markers of portal hypertension are splenomegaly, increased portal vein diameter, thrombocytopenia and presence of varices on endoscopy. The next step is to evaluate the etiology of CLD which will depend on the age of the child and needs targeted investigations as metabolic and inherited causes predominate in early childhood. CLD progression ought to be monitored regularly and several non-invasive markers are available but they have to be evaluated further in children. Since CLD progresses, complications have to be detected early not only to initiate appropriate treatment but also to prognosticate.
Topics: Child; Adult; Child, Preschool; Humans; Esophageal and Gastric Varices; Hypertension, Portal; Portal Vein; Endoscopy; Liver Cirrhosis; Gastrointestinal Hemorrhage; Chronic Disease
PubMed: 37702974
DOI: 10.1007/s12098-023-04751-1 -
Langenbeck's Archives of Surgery Oct 2023The incidence of portal vein thrombosis (PVT) at the time of liver transplantation (LT) may be variable and underestimated. Therefore, preoperative diagnosis and...
BACKGROUND
The incidence of portal vein thrombosis (PVT) at the time of liver transplantation (LT) may be variable and underestimated. Therefore, preoperative diagnosis and stratification of its extension is so relevant for adequate surgical planning. Revascularization of the portal vein graft becomes essential for graft and patient survival after LT. Early stages of PVT may be managed with eversion thrombectomy and end-to-end anastomoses. However, severe PVT (grades 3 and 4) poses significant challenges for patients requiring LT, resulting in more complex surgeries and higher complication rates. To address these complexities, various surgical techniques have been developed, including collateral alternative vessel utilization, renoportal anastomoses, mesoportal jump graft placement, cavoportal hemitranspositions, portal vein arterialization, or even multivisceral transplantation.
PURPOSE
We herein describe the preoperative surgical planning as well as the different surgical strategies possible to treat portal vein thrombosis during LT.
CONCLUSION
A comprehensive preoperative evaluation of PVT is crucial for accurately assessing its extent and severity. This information is vital for proper surgical planning, which ultimately prepares both the surgeon and the patient for potentially complex procedures during LT. The surgical alternatives presented in this technical report offer promising solutions for treating PVT during LT, making it a viable option for selected patients.
Topics: Humans; Adult; Liver Transplantation; Portal Vein; Liver Diseases; Anastomosis, Surgical; Venous Thrombosis
PubMed: 37831179
DOI: 10.1007/s00423-023-03141-7