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Cardiovascular and Interventional... Nov 2021This animal experimental study evaluated how hepatic artery and portal vein transient occlusion affects the ablation zone of hepatic radiofrequency ablation (RFA).
PURPOSE
This animal experimental study evaluated how hepatic artery and portal vein transient occlusion affects the ablation zone of hepatic radiofrequency ablation (RFA).
MATERIAL AND METHODS
Twenty-one rabbits were divided into three groups of seven each: (1) control, (2) hepatic artery occlusion, and (3) portal vein occlusion by a balloon catheter. For each rabbit, two or three RFA sessions were performed using an electrode needle. Ablation time, temperature around the tip of RFA needle at the end of RFA, ablation volume on fat-suppressed T1-weighted image in the hepatobiliary phase, and coagulative necrosis area on histopathology were measured and compared between the three groups using the Kruskal-Wallis paired Mann-Whitney U tests.
RESULTS
In 43 RFA sessions (group 1, 15; group 2, 14; group 3, 14), mean tissue temperature in group 3 (77.0 °C ± 7.7 °C) was significantly higher compared to groups 1 (59.2 °C ± 18.8 °C; P = 0.010) and 2 (67.5 °C ± 9.9 °C; P = 0.010). In addition, mean ablation volume and coagulative necrosis in group 3 (2.10 ± 1.37 mm and 0.86 ± 0.28 mm, respectively) were larger compared to groups 1 (0.84 ± 0.30 mm; P < 0.001 and 0.55 ± 0.26 mm; P = 0.020, respectively) and 2 (0.89 ± 0.59 mm; P = 0.002 and 0.60 ± 0.22 mm; P = 0.024, respectively).
CONCLUSION
Portal vein occlusion potentially boosts tissue temperature, ablation volume, and area of histopathologically proven coagulative necrosis during hepatic RFA in the non-cirrhotic liver.
Topics: Animal Experimentation; Animals; Catheter Ablation; Hepatic Artery; Portal Vein; Rabbits; Radiofrequency Ablation
PubMed: 34231011
DOI: 10.1007/s00270-021-02822-4 -
BMC Surgery Sep 2023As an emerging standard of care for portal vein cavernous transformation (PVCT), Meso-Rex bypass (MRB) has been complicated and variated. The study aim was to propose a...
BACKGROUND
As an emerging standard of care for portal vein cavernous transformation (PVCT), Meso-Rex bypass (MRB) has been complicated and variated. The study aim was to propose a new classification of PVCT to guide MRB operations.
METHODS
Demographic data, the extent of extrahepatic PVCT, surgical methods for visceral side revascularization, intraoperative blood loss, operating time, changes in visceral venous pressure before and after MRB, postoperative complications and the condition of bypass vessels after MRB were extracted retrospectively from the medical records of 19 patients.
RESULTS
The median age of the patients (13 males and 6 females) was 32.5 years, while two patients were underage. Causes of PVCT can be summarized as follows: thrombophilia such as dysfunction of antithrombin III or proteins C; secondary to abdominal surgeries; secondary to abdominal infection or traumatic intestinal obstruction, and unknown causes. Intraoperatively, the median operation time was 9.5 h (7-13 h), and the intraoperative blood loss was 300 mL (100-1,600 mL). Ten cases used autologous blood vessels while 10 used allogeneic blood vessels. The vascular anastomosis was divided into the following types according to the site and approach: Type (T) 1-PV pedicel type, T2-confluence type, T3-major visceral vascular type; and T4-collateral visceral vascular type. Furthermore, the visceral venous pressure before and after MRB dropped significantly from 36 cmHO (28-44) to 24.5 cmHO (15-31) (P < 0.01). Postoperatively, one patient had delayed wound healing, two developed biochemical pancreatic fistulae, one experienced lymphatic leakage, the former caused by heat damage of the pancreatic tissues, the latter by cutting lymphatic vessels in the mesentery or removing the local lymph nodes during the process of separating the superior mesenteric vein, and one was re-operated on for an intervening intestinal fistulae. Postoperative enhanced CT scans revealed a significant improvement in abdominal varix in the patients with patent bypass, and at the 1-year postoperative follow-up, enhanced CT scans of six patients showed that the long axis of the spleen was reduced by ≥ 2 cm.
CONCLUSIONS
MRB can effectively reduce visceral venous pressure in patients with PVCT. It is feasible to determine the PVCT type according to the extent of involvement and to choose individualized visceral side revascularization performances.
Topics: Female; Male; Humans; Adult; Portal Vein; Blood Loss, Surgical; Retrospective Studies; Vascular Surgical Procedures; Spleen
PubMed: 37705015
DOI: 10.1186/s12893-023-02168-3 -
Annals of Anatomy = Anatomischer... Feb 2024It is known that there are varying frequencies of hepatic portal vein branching patterns found in the literature. Studies use different methods and classifications to... (Review)
Review
BACKGROUND
It is known that there are varying frequencies of hepatic portal vein branching patterns found in the literature. Studies use different methods and classifications to evaluate the anatomy of the portal vein, which limits accurate comparison between studies and the determination of true frequency of branching patterns in different populations. The aim of the present study was to investigate the intrahepatic branching of the portal vein in corrosive samples using different methods - somatoscopic and computed tomography (CT) and compare with similar studies as well as compare the reclassified data according to the most popular classifications used in the literature.
METHODS
A total of 105 liver corrosion specimens from the 1960-1980 period (51 male and 54 female individuals; min-max age variation - 21-90 y., M=59,46 y.) were investigated. The branching patterns of the hepatic portal vein (HPV), left (HPV-LB) and right branch of hepatic portal vein (HPV-RB), and their segmental branches were examined and scanned by CT. Standard HPV ramification was considered, when HPV divided into HPV-LB and HPV-RB, HPV-RB bifurcated to the anterior and posterior branches, and further segmental ramification into the superior and inferior branches was considered standard. We compared the HPV main branch length and diameter measurements between manual and CT method. A review of the literature was performed on portal vein branching variations.
RESULTS
The standard HPV ramification pattern was detected in 85.7% of the cases in both somatoscopic and CT evaluation. Variations related to the main branches were HPV trifurcation - 7.6%, posterior branch of right branch of hepatic portal vein from HPV - 4.8% and 5.7%, HPV quadrifurcation 1.9% and 1% respectively, in somatoscopic and CT evaluation. There was a significant difference between HPV-LB length and diameter in CT and manual measurements. According to the literature, more variations are seen using the CT method versus somatoscopic corrosion cast evaluation. The varying frequency in studies may be explained by a lack of one unanimous classification of branching patterns (some authors do not consider segmental variations as standard HPV ramification) and different evaluation methods.
CONCLUSION
Somatoscopic evaluation of the branching patterns of the hepatic portal vein in corroded specimens and their CT reconstructions did not differ significantly (which allows relatively accurate comparison of old specimens with newer data). However, the ability to evaluate the reconstructed 3D images of the specimens allowed a more accurate assessment of segmental branching and measurements of lengths and diameters. Standard HPV branching (according to a self-developed classification) in this study was 85.7%. Depending on the classification, the rate of standard branching in the same corrosive samples varied from 63.8% to 84.8% of all cases, indicating that the lack of a unified and stable classification makes it difficult to compare the results of different studies. Deviations from standard branching are very important in surgical procedures and liver transplantation.
Topics: Male; Humans; Female; Portal Vein; Caustics; Papillomavirus Infections; Liver; Tomography, X-Ray Computed
PubMed: 38142799
DOI: 10.1016/j.aanat.2023.152204 -
HPB : the Official Journal of the... May 2023Vascular complications after liver transplantation (LT) can be lethal and require immediate treatment to prevent graft failure. Nowadays, with interventional radiology... (Review)
Review
BACKGROUND
Vascular complications after liver transplantation (LT) can be lethal and require immediate treatment to prevent graft failure. Nowadays, with interventional radiology (IR), approaches such as the percutaneous transhepatic (PTH) and transileocolic venous (TIC), have become major treatment options. We reviewed the safety and efficacy of a hybrid operating room (OR) for portal vein complications after LT.
METHODS
Patients who underwent IR for post-LT vascular complications in the hybrid OR from May 2014 to May 2022 were enrolled. Patients who underwent post-LT IR in conventional angiography rooms were excluded.
RESULTS
Nine patients developed portal vein complications; eight after living donor LT and one after deceased donor LT. Six patients had portal vein stenosis, two had portal vein thrombosis, and one had both. In the hybrid OR, PTH and TIC were used in five and three cases, respectively. The Rendezvous technique was used in one case. Angioplasty was performed in all patients. A stent was placed in four patients. The portal venous pressure gradient across the stenotic site significantly decreased after IR (P &= 0.031). The IR success rate in the hybrid OR was 100%.
CONCLUSION
The hybrid OR enables us to accomplish IR for post-LT vascular complications safely and effectively.
Topics: Humans; Portal Vein; Liver Transplantation; Operating Rooms; Treatment Outcome; Venous Thrombosis; Constriction, Pathologic; Stents
PubMed: 36822928
DOI: 10.1016/j.hpb.2023.01.020 -
Hepatobiliary & Pancreatic Diseases... Oct 2024Cavernous transformation of the portal vein (CTPV) due to portal vein obstruction is a rare vascular anomaly defined as the formation of multiple collateral vessels in...
BACKGROUND
Cavernous transformation of the portal vein (CTPV) due to portal vein obstruction is a rare vascular anomaly defined as the formation of multiple collateral vessels in the hepatic hilum. This study aimed to investigate the imaging features of intrahepatic portal vein in adult patients with CTPV and establish the relationship between the manifestations of intrahepatic portal vein and the progression of CTPV.
METHODS
We retrospectively analyzed 14 CTPV patients in Beijing Tsinghua Changgung Hospital. All patients underwent both direct portal venography (DPV) and computed tomography angiography (CTA) to reveal the manifestations of the portal venous system. The vessels measured included the left portal vein (LPV), right portal vein (RPV), main portal vein (MPV) and the portal vein bifurcation (PVB).
RESULTS
Nine males and 5 females, with a median age of 40.5 years, were included in the study. No significant difference was found in the diameters of the LPV or RPV measured by DPV and CTA. The visualization in terms of LPV, RPV and PVB measured by DPV was higher than that by CTA. There was a significant association between LPV/RPV and PVB/MPV in term of visibility revealed with DPV (P = 0.01), while this association was not observed with CTA. According to the imaging features of the portal vein measured by DPV, CTPV was classified into three categories to facilitate the diagnosis and treatment.
CONCLUSIONS
DPV was more accurate than CTA for revealing the course of the intrahepatic portal vein in patients with CTPV. The classification of CTPV, that originated from the imaging features of the portal vein revealed by DPV, may provide a new perspective for the diagnosis and treatment of CTPV.
Topics: Humans; Portal Vein; Male; Female; Retrospective Studies; Adult; Middle Aged; Computed Tomography Angiography; Phlebography; Predictive Value of Tests; Young Adult; Aged; Portography; Collateral Circulation; Hypertension, Portal
PubMed: 36693772
DOI: 10.1016/j.hbpd.2023.01.002 -
Pediatric Transplantation Dec 2023
Topics: Humans; Child; Portal Vein; Portasystemic Shunt, Transjugular Intrahepatic; Hypertension, Portal; Treatment Outcome; Retrospective Studies
PubMed: 37291804
DOI: 10.1111/petr.14554 -
Ultrasound in Medicine & Biology Jan 2023The current gold standard for the clinical diagnosis of portal hypertension (PH) is an invasive and indirect estimation of portal vein pressure (PVP). Therefore, the...
The current gold standard for the clinical diagnosis of portal hypertension (PH) is an invasive and indirect estimation of portal vein pressure (PVP). Therefore, the need for a non-invasive PVP measurement method is urgent. Subharmonic scattering of ultrasound contrast agent (UCA) microbubbles is under investigation in clinical research as a pressure indicator. However, the driving acoustic pressure must be optimized to improve the ambient pressure sensitivity of the subharmonic amplitude for different UCAs. In this study, for the first time, we obtained the relationship between the PVP and the amplitude of the subharmonic signal scattered from SonoVue microbubbles by using two canines to build the PH model. The results revealed a desirable linear correlation between the subharmonic amplitude and PVP (<20 mmHg) at the incident acoustic pressure of 453 kPa (r = -0.910, p < 0.005; sensitivity: -2.003 dB/mmHg); this was one order of magnitude higher in sensitivity than that of the in vitro case with a detectable pressure variation of approximately 1 mmHg. This indicates the feasibility of using UCA microbubbles to accurately measure low ambient pressures in vivo and further exhibits the potential of the method for non-invasive pressure estimation in clinical applications.
Topics: Dogs; Animals; Microbubbles; Portal Vein; Sulfur Hexafluoride; Phospholipids; Contrast Media; Ultrasonography; Hypertension, Portal
PubMed: 36266141
DOI: 10.1016/j.ultrasmedbio.2022.08.014 -
Medical Ultrasonography Feb 2022According to a novel in-utero classification termed "umbilical-portal-systemic venous shunt (UPSVS)" recently proposed for an abnormal umbilical, portal and ductal...
AIMS
According to a novel in-utero classification termed "umbilical-portal-systemic venous shunt (UPSVS)" recently proposed for an abnormal umbilical, portal and ductal venous system, the portal-systemic shunt belongs to type III UPSVS. This study was designed to examine the ultrasonographic characteristics and outcome of type III UPSVS.Material and methods: All cases of Type III UPSVS diagnosed at our department from April 2016 to December 2020 were retrospectively studied.
RESULTS
Seventeen patients with type III UPSVS including 12 type IIIa and 5 IIIb cases were identified. Sonography showed a shunt between the inferior left portal vein and the left hepatic vein in all type IIIa cases. Three cases of type IIIb had a combination of another shunt (2 with type I and one with type IIIa). Integrate intrahepatic portal vein system was not seen in those 2 cases of type IIIb combined with type I UPSVS, leading to termination of pregnancy (TOP). TOP occurred in 4 patients with type IIIa as requested by the parents. Two cases (type IIIa and type IIIb each) underwent surgical procedure for the closure of the shunt. Spontaneous complete closure in 4 type IIIa cases and partial closure in one type IIIb case occurred during a period of 3-16 months.
CONCLUSIONS
The majority of patients had type IIIa UPSVS presenting a good outcome. The lack of integrate intrahepatic portal vein system was the main reason for TOP in patients with type IIIb UPSVS. These data suggest the UPSVS classification is a useful tool for a prognosis prediction of type III UPSVS.
Topics: Female; Humans; Portal Vein; Pregnancy; Prognosis; Retrospective Studies
PubMed: 34216452
DOI: 10.11152/mu-3163 -
Surgery Today Feb 2023During surgical resection of malignant tumors in the hepatobiliary pancreatic region, portal vein resection and reconstruction may be needed. However, there is no...
PURPOSE
During surgical resection of malignant tumors in the hepatobiliary pancreatic region, portal vein resection and reconstruction may be needed. However, there is no alternative to the portal vein. We therefore developed an artificial portal vein that could be used in the abdominal cavity.
METHODS
In the experiments, hybrid pigs (n = 8) were included. An artificial portal vein was created using a bioabsorbable polymer sheet (BAPS). Subsequently, the portal vein's anterior wall was excised into an elliptical shape. A BAPS in the form of a patch was implanted at the same site. At 2 weeks (n = 3) and 3 months (n = 5) after the implantation, the BAPS implantation site was resected and evaluated macroscopically and histopathologically.
RESULTS
Immediately after the implantation, blood leakage was not detected. Two weeks after implantation, the BAPS remained, and endothelial cells were observed. Thrombus formation was not observed. Three months after implantation, the BAPS had been completely absorbed and was indistinguishable from the surrounding portal vein. Stenosis and aneurysms were not observed.
CONCLUSIONS
BAPS can replace a defective portal vein from the early stage of implantation to BAPS absorption. These results suggest that it can be an alternative material to the portal vein in surgical reconstruction.
Topics: Animals; Swine; Portal Vein; Absorbable Implants; Polymers; Endothelial Cells; Pancreas
PubMed: 35842849
DOI: 10.1007/s00595-022-02555-y -
Radiology Apr 2023
Topics: Humans; Hypertension, Portal; Portal Vein; Tomography, X-Ray Computed
PubMed: 36719296
DOI: 10.1148/radiol.223163