Propranolol for portal hypertension. Evaluation of therapeutic response by direct measurement of portal vein pressure

1985 ◽  
Vol 145 (4) ◽  
pp. 648-650 ◽  
Author(s):  
W. G. Rector
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Direct Measurement ◽  
Therapeutic Response ◽  
Portal Vein Pressure

scholarly journals The Surgical Treatment for Portal Hypertension: A Systematic Review and Meta-Analysis

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Lanning Yin ◽  
Haipeng Liu ◽  
Youcheng Zhang ◽  
Wen Rong
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Variceal Bleeding ◽  
Meta Analysis ◽  
Portal Pressure ◽  
Combined Treatment ◽  
Cochrane Library ◽  
Quality Of Reporting ◽  
Portal Vein Pressure ◽  
Shunt Procedure

Aim. To compare the effectiveness of surgical procedures (selective or nonselective shunt, devascularization, and combined shunt and devascularization) in preventing recurrent variceal bleeding and other complications in patients with portal hypertension. Methods. A systematic literature search of the Medline and Cochrane Library databases was carried out, and a meta-analysis was conducted according to the guidelines of the Quality of Reporting Meta-Analyses (QUOROM) statement. Results. There were a significantly higher reduction in rebleeding, yet a significantly more common encephalopathy () in patients who underwent the shunt procedure compared with patients who had only a devascularization procedure. Further, there were no significant differences in rebleeding, late mortality, and encephalopathy between selective versus non-selective shunt. Next, the decrease of portal vein pressure, portal vein diameter, and free portal pressure in patients who underwent combined treatment with shunt and devascularization was more pronounced compared with patients who were treated with devascularization alone (). Conclusions. This meta-analysis shows clinical advantages of combined shunt and devascularization over devascularization in the prevention of recurrent variceal bleeding and other complications in patients with portal hypertension.

Endoscopic Ultrasound for the Hepatologist: A Comprehensive Review

2018 ◽  
Vol 38 (02) ◽  
pp. 145-159
Author(s):  
Mihai Rimbaş ◽  
Luca Di Maurizio ◽  
Gianenrico Rizzatti ◽  
Antonio Gasbarrini ◽  
Guido Costamagna ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Endoscopic Ultrasound ◽  
Liver Diseases ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Portal Vein Pressure ◽  
Comprehensive Review ◽  
Parenchymal Liver ◽  
Hypertension Portal

AbstractIn the last few years, the diagnostic and therapeutic utilization of endoscopic ultrasound (EUS) for a variety of liver conditions has exponentially grown. We performed a thorough search for all available studies on the performance of diagnostic and therapeutic EUS in the field of hepatology. This article reviews the indication of EUS in the evaluation and treatment of portal hypertension, portal vein pressure measurement, focal liver lesions, and parenchymal liver diseases, and presents all the clinical evidences available so far in this regard. All the review data suggest that EUS is becoming an increasingly important tool in the armamentarium of the hepatologists for the management of certain liver-related conditions. Implementation in the education of the hepatologists of means to become more familiar with both diagnostic and therapeutic capabilities of EUS is warranted.

scholarly journals A228 WHEN ASCITES & VARICEAL BLEEDING ARE NOT FROM CIRRHOSIS: A CASE OF MUTIPLE ARTERIOPORTAL FISTULAE CAUSING PORTAL HYPERTENSION

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 265-266
Author(s):  
K Leung ◽  
A Jaberi ◽  
J Kachura ◽  
K Duan ◽  
D Wong
Keyword(s):  
Portal Hypertension ◽  
Liver Biopsy ◽  
Portal Vein ◽  
High Pressures ◽  
Transient Elastography ◽  
Right Heart Failure ◽  
Endovascular Embolization ◽  
Nodular Regenerative Hyperplasia ◽  
Portal Vein Pressure ◽  
Hepatic Portal

Abstract Background Portal hypertension is usually due to increased resistance from cirrhosis. However, pressures can also be elevated due to increased flow. Aims To describe a peculiar case of non-cirrhotic portal hypertension. Methods A case report and literature review was performed. Results A 47-year-old previously well man presented with a 6 month history of rapidly progressive weight loss, ascites and variceal bleed. Workup ruled out common causes of primary liver disease. Initial imaging demonstrated a heterogenous liver, splenomegaly, ascites, patent hepatic/portal veins and multiple poorly defined low-density hepatic lesions with the largest measuring 2.1 cm. Transient elastography was 7.3 kPa (F1-mild fibrosis). At transjugular liver biopsy, hepatic venogram ruled out Budd-Chiari and hepatic vein pressure gradient was normal at 3–4 mmHg. Histology unfortunately showed hemangioma. A percutaneous liver biopsy suggested nodular regenerative hyperplasia, minimal fibrosis and mild cholestasis. Given worsening ascites, hyponatremia and 7 months of rapidly progressive decline, transjugular intrahepatic portosystemic shunt (TIPSS) was inserted. Intra-procedure, portal vein pressure was noted to be 51 mmHg, with a portosystemic gradient of 42 mmHg. Although numerous abdominal CT and MRI did not show AV shunting, ultrasound post-TIPSS showed hepatic pseudoaneurysms & arterioportal fistulae (APF). Direct angiogram showed numerous hepatic pseudoaneurysms and intrahepatic fistulae making embolization impossible. CT showed no evidence of pseudoaneurysms or fistulae outside of the liver. Workup for autoimmune rheumatological diseases and congenital telangiectatic syndromes were negative. Given the high pressures being directed through the new TIPSS, right heart failure is an ongoing concern. APF are rarely encountered causes of presinusoidal portal hypertension, with communications most commonly arising from the hepatic (65%) & splenic arteries (11%) & the portal vein. Causes include traumatic (28%), iatrogenic (16%), vascular/telangiectatic malformations (15%), tumors (15%), aneurysms (14%) & congenital disease. Endovascular embolization can be used to treat single lesions. In complex cases with mulitple APF, surgery and/or liver transplantation may be required. Conclusions We report a rare case of non-cirrhotic portal hypertension due to increased flow rather than increased resistance secondary to APF. Funding Agencies None

Percutaneous transhepatic portal vein stenting as rescue treatment for recurrent oesophageal variceal bleeding in a 31-year-old woman with haepatocellular carcinoma in a non-cirrhotic liver

2020 ◽  
Vol 13 (12) ◽  
pp. e235161
Author(s):  
Colin Andreas Jan van Kalkeren ◽  
Zlatan Mujagic ◽  
Jef Verbeek ◽  
Michiel W de Haan
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Variceal Bleeding ◽  
Treatment Options ◽  
Recurrent Bleeding ◽  
Line Treatment ◽  
Portal Vein Pressure ◽  
Rescue Treatment ◽  
Endoscopic Band Ligation ◽  
All Treatment

A 31-year-old woman with hepatocellular carcinoma suffered from recurrent oesophageal variceal bleeding due to portal hypertension, which was caused by severe compression of the portal vein by metastatic lymph nodes. Endoscopic band ligation and pharmacological treatment did not suffice to prevent recurrence of variceal bleeding. Eventually, after the fifth variceal bleeding within 6 months, the patient was admitted to the intensive care unit in a haemodynamic shock. A Sengstaken-Blakemore tube was inserted and all treatment options were discussed, but only percutaneous transhepatic recanalisation of the portal vein with stent placement to reduce portal vein pressure was thought to be feasible with any chance to relieve portal vein pressure. After successful portal vein stenting, our patient did not have any recurrent bleeding in the remaining year of her life. We suggest that percutaneous transhepatic portal vein stenting may be a feasible and adequate last line treatment for complications of portal hypertension.

Decompensated Acute Heart Failure Accompanied with Cardiac Cirrhosis and Chronic Disease Anemia in Child

2020 ◽  
Vol 1 (2) ◽  
pp. 71-76
Author(s):  
Tommy Darmasaputra
Keyword(s):  
Heart Failure ◽  
Portal Hypertension ◽  
Chronic Disease ◽  
Portal Vein ◽  
Decompensated Heart Failure ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Portal Vein Pressure ◽  
Converting Enzyme Inhibitors ◽  
Pharmacological Management ◽  
Cardiac Cirrhosis

Continuous heart failure can lead to complications to other systems, one of which is the hepatic system. Heart failure results in venous congestion in the portal vein so that the portal vein pressure increases, which is called portal hypertension. Portal hypertension causes fluid to pass through the walls of blood vessels and into the tissues. Management of decompensatory heart failure accompanied by comorbid disease in cardiac cirrhosis includes drugs management that does not aggravate the liver, namely angiotensin converting enzyme inhibitors and loop diuretic agents. Also, non-pharmacological management such as resting position and a diet sufficient in protein and low salt help improve the patient's general condition. This case report aims to present a decompensated heart failure accompanied by cardiac cirrhosis and anaemia of chronic disease in a child.

Stability of a rat model of prehepatic portal hypertension caused by partial ligation of the portal vein

2009 ◽  
Vol 15 (32) ◽  
pp. 3449
Author(s):  
Zhe Wen ◽  
Jin-Zhe Zhang ◽  
Hui-Min Xia ◽  
Chun-Xiao Yang ◽  
Ya-Jun Chen
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Rat Model

scholarly journals Stent patency and outcome of TIPS through the left versus the right portal branches

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Mohamed S. Alwarraky ◽  
Hasan A. Elzohary ◽  
Mohamed A. Melegy ◽  
Anwar Mohamed
Keyword(s):  
Portal Hypertension ◽  
Clinical Outcome ◽  
Portal Vein ◽  
Variceal Bleeding ◽  
Patency Rate ◽  
Hospital Admissions ◽  
Stent Patency ◽  
Left Branch ◽  
The Right

Abstract Background Our purpose is to compare the stent patency and clinical outcome of trans-jugular intra-hepatic porto-systemic shunt (TIPS) through the left branch portal vein (TIPS-LPV) to the standard TIPS through the right branch (TIPS-RPV). We retrospectively reviewed all patients (n = 54) with refractory portal hypertension who were subjected to TIPS-LPV at our institute (TIPS-LPV) between 2016 and 2018. These patients were matched with 56 control patients treated with the standard TIPS-RPV (TIPS-RPV). The 2 groups were compared regarding the stent patency rate, encephalopathy, and re-interventions for 1 year after the procedure. Results TIPS-LPV group showed 12 months higher patency rate (90.7% compared to 73.2%) (P < 0.005). The number of the encephalopathy attacks in the TIPS-LPV group was significantly lower than that of the TIPS-RPV group at 6 and 12 months of follow-up [P = 0.012 and 0.036, respectively]. Re-bleeding and improvement of ascites were the same in the two groups [P > 0.05]. Patients underwent TIPS-LPV needed less re-interventions and required less hospitalizations than those with TIPS-RPV [P = 0.039 and P = 0.03, respectively]. Conclusion The new TIPS approach is to extend the stent to LPV. This new TIPS-LPV approach showed the same clinical efficiency as the standard TIPS-RPV in treating variceal bleeding and ascites. However, it proved a better stent patency with lower rates of re-interventions, encephalopathy, and hospital admissions than TIPS through the right branch.

scholarly journals A comparative study of multi-detector CT portography versus endoscopy in evaluation of gastro-esophageal varices in portal hypertension patients

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Hany El-Assaly ◽  
Lamiaa I. A. Metwally ◽  
Heba Azzam ◽  
Mohamed Ibrahim Seif-Elnasr
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Esophageal Varices ◽  
Imaging Modality ◽  
Splenic Vein ◽  
Gastric Varices ◽  
Gi Endoscopy ◽  
Upper Gi ◽  
Upper Gi Endoscopy ◽  
Vein Diameter

Abstract Background Portal hypertension is a major complication resulting from obstruction of portal blood flow, like cirrhosis or portal vein thrombosis, that leads to portal hypertension. MDCT angiography has become an important tool for investigation of the liver as well as potentially challenging varices by detailing the course of these tortuous vessels. This information is decisive for liver transplantation as well as for common procedures in which an unexpected varix can cause significant bleeding. Results This study included an assessment of 60 cases of portal hypertension (28 males and 32 females), their age ranged from 42 to 69 years (mean age = 57.2 ± 6.63). All patients were diagnosed with portal hypertension, underwent upper GI endoscopy followed by a triphasic CT scan with CT angiographic assessment for the screening of gastro-esophageal varices. CT is highly sensitive as compared to upper GI endoscopy (sensitivity 93%) in detecting esophageal varices. Gastric varices detected by CT in 22 patients (37%) compared to 14 patients (23%) detected by endoscopy. While paraesophageal varices were detected in 63% of patients and retro-gastric varices in 80% of patients that were not visualized by endoscopy. Our study reported that the commonest type of collaterals were the splenic collaterals, and we also found there is a significant correlation between the portal vein diameter and the number of collaterals as well as between the portal vein diameter and splenic vein diameter. Conclusions Multi-slice CT serves as an important non-invasive imaging modality in the diagnosis of collaterals in cases of portal hypertension. CT portography can replace endoscopy in the detection of high-risk varices. It also proved that there is a correlation between portal vein diameter, splenic vein diameter, and number of collaterals.

scholarly journals Multidisciplinary treatment of left hepatic artery pseudoaneurysm after hepatobiliary resection for gallbladder cancer: a case report

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Ryusei Yamamoto ◽  
Teiichi Sugiura ◽  
Yukiyasu Okamura ◽  
Takaaki Ito ◽  
Yusuke Yamamoto ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Liver Failure ◽  
Hepatic Artery ◽  
Remnant Liver ◽  
Left Hepatic Artery ◽  
Artery Pseudoaneurysm ◽  
Hepatobiliary Resection ◽  
Portal Vein Arterialization ◽  
Arterial Inflow

Abstract Background When a postoperative hepatic artery pseudoaneurysm develops after massive hepatectomy, both an intervention for the pseudoaneurysm and patency of hepatic artery should be considered because occlusion of the residual hepatic artery results in critical liver failure. However, the treatment strategy for a pseudoaneurysm of the hepatic artery after hepatobiliary resection is not well established. Case presentation A 65-year-old woman underwent right hepatectomy, extrahepatic duct resection, and portal vein resection, for gallbladder cancer. Although the patient had an uneventful postoperative course, computed tomography on postoperative day 6 showed a 6-mm pseudoaneurysm of the hepatic artery. Angiography revealed the pseudoaneurysm located on the bifurcation of the left hepatic artery to the segment 2 artery plus the segment 3 artery and 4 artery. Stent placement in the left hepatic artery was not feasible because the artery was too narrow, and coiling of the pseudoaneurysm was associated with a risk of occluding the left hepatic artery and inducing critical liver failure. Therefore, portal vein arterialization constructed by anastomosing the ileocecal artery and vein was performed prior to embolization of the pseudoaneurysm to maintain the oxygen level of the remnant liver, even if the left hepatic artery was accidentally occluded. The pseudoaneurysm was selectively embolized without occlusion of the left hepatic artery, and the postoperative laboratory data were within normal limits. Although uncontrollable ascites due to portal hypertension occurred, embolization of the ileocolic shunt rapidly resolved it. The patient was discharged on postoperative day 45. Conclusion Portal vein arterialization prior to embolization of the aneurysm may be a feasible therapeutic strategy for a pseudoaneurysm that develops after hepatectomy for hepatobiliary malignancy to guarantee arterial inflow to the remnant liver. Early embolization of arterioportal shunting after confirmation of arterial inflow to the liver should be performed to prevent morbidity induced by portal hypertension.

Sign in / Sign up

Export Citation Format

Share Document