scholarly journals The topographo-anatomical conditions of reconstruction of the trunk and roots of the portal vein during gastropancreatoduodenal resection

2021 ◽  
Vol 23 (1) ◽  
pp. 33-40
Author(s):  
Iliya I. Dzidzava ◽  
Ivan V. Gayvoronsky ◽  
Andrei B. Kotiv ◽  
Sergey A. Alentyev
Keyword(s):  
Computed Tomography ◽  
Portal Vein ◽  
Tumor Invasion ◽  
Vascular System ◽  
Splenic Vein ◽  
Vascular Reconstruction ◽  
Portal System ◽  
Vein Wall ◽  
Pancreatic Stump ◽  
Extended Contact

Topographic and anatomical variants of vascular plastics in extended gastropancreatoduodenal resection are substantiated. The anatomical study was performed on 30 organ complexes and 5 not embalmed human corpses. Significant variability of the roots and tributaries of the v. portae and their location near the pancreas was revealed. The extended contact of the mesenteric-portal segment with the head of the pancreas promotes the involvement of the veins of the portal system in the tumor process. The magistral type of the structure of the superior mesenteric vein was revealed in 19 cases, the distributed type in 11, which determines the conditions for vascular reconstruction. In the experiment the possibility of creation the formation of the direct mesenteric-portal anastomosis after duodenectomy was established in case of shifting the mobilized root of the mesentery of the small intestine in the direction of the liver gate. If splenic vein resection is necessary, adequate blood outflow from the stomach, spleen, and pancreatic stump can be provided by forming a distal splenic-renal anastomosis or, with a sufficient length of the splenic vein, a splenic-portal anastomosis. Based on computed tomography angiographs and intraoperative data 29 patients underwent extended gastropancreatoduodenal resection followed by vascular reconstruction. Tumor invasion of the trunk of the portal vein on computed tomography angiograms was represented by offset and the contact of the tumor with portal vein for over 10 mm (in 7 cases), the displacement and deformation of the portal vein tumor (in 5 cases), tumor infiltration of more than 50% of the circumference of the portal vein (in 3 cases). Extended contact with the tumor was identified in 9 cases, confluence stenosis of the portal vein in 5 cases. The tumor invasion into the portal vein, and the vascular system was restored by the formation of a port-portal anastomosis in 15 cases. Moreover at the reconstruction of mesenteric-portal segment we formed mesenteric-portal anastomosis in 10 cases. Also in 2 cases mesenteric-portal anastomosis in the confluence area of the iliac colon and jejunum tributaries was formed, in 1 case we formed anastomosis between the ileum-colon vein and the portal vein (with 1:2 diameter difference without patency disorders). In one single case we connected iliac colon vein wall with jejunum vein wall and formed anastomosis between them and portal vein. Distal splenorenal anastomosis was formed in 10 patients from this group. Spleno-portal anastomosis was formed in 3 patients above the junction of the portal and superior mesenteric veins.

scholarly journals The Congenital Absence of the Portal Vein

2020 ◽  
pp. 1-2
Author(s):  
M Lagrine ◽  
◽  
A Bourrahouat ◽  
I Ait Sab ◽  
M Sbihi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Portal Vein ◽  
Superior Mesenteric Vein ◽  
Liver Tumors ◽  
Splenic Vein ◽  
Abdominal Ultrasound ◽  
Congenital Absence ◽  
Grade Ii ◽  
Upper Gastrointestinal ◽  
Portal Trunk

Congenital absence of the portal vein (CAPV) is a rare defect often accompanied by other abnormalities such as heart defect, skeletal anomalies and / or liver tumors [1]. We describe here a case of CAPV revealed by an upper gastrointestinal tract hemorrhage in a child aged 02 years and 8 months. The esogatro-duodenal fibroscopy revealed the presence of Esophageal varices grade II, abdominal ultrasound revealed a large liver with no visualization of the spleen. Subsequent abdominal computed tomography revealed the presence of a spleno-mesaraic trunk measuring 7 mm in anteroposterior diameter receiving the inferior and superior mesenteric vein and a small splenic vein draining by dilated peri-gastric and peri-esophageal leads. Associated with splenic hypoplasia and portal trunk atresia. The rest of the malformative assessment was negative

scholarly journals ANATOMICAL VARIANTS OF INFERIOR MESENTERIC VEIN ACCORDING ON THE DATA OF MULTISPIRAL COMPUTED TOMOGRAPHY

2021 ◽  
Vol 28 (4) ◽  
pp. 31-37
Author(s):  
Aleksandr V. Kolsanov ◽  
Maksim N. Myakotnykh ◽  
Aleksey A. Mironov ◽  
Renat R. Yunusov
Keyword(s):  
Computed Tomography ◽  
Portal Vein ◽  
Superior Mesenteric Vein ◽  
Splenic Vein ◽  
Common Trunk ◽  
Inferior Mesenteric Vein ◽  
Mesenteric Vein ◽  
Vein Formation ◽  
Vascular Bed ◽  
The Common

Knowledge of the variants of the anatomical variability of the liver vascular bed can be of critical importance in liver resection, liver transplantation, laparoscopic operations, resection of the pancreas, surgical treatment of portal hypertension The main vessels of the hepatic portal vein system are characterized by pronounced anatomical variability in the formation of the portal vein trunk, the greatest variability is characterized by inferior mesenteric vein. The aim of the investigation was to study the variant anatomy of the inferior mesenteric vein according to multispiral computed tomography. The material was 100 multispiral computed tomograms of the abdominal organs from the archive of the clinics of the Samara State Medical University for 2018-2019. For mathematical modeling and the creation of three-dimensional models based on tomograms of the vascular bed, plugins were used in the programs «Luch» and «Autoplan». Variants of the portal vein formation, the angle of inflow of the inferior mesenteric vein into the superior mesenteric and splenic veins, the distance from the point of confluence of the inferior mesenteric vein to the point of confluence with the portal vein were studied. The study revealed that the inferior mesenteric vein in 40% of cases flows into the splenic vein, in 39% - into the angle of confluence of the superior mesenteric and splenic veins, in 16% - into the superior mesenteric vein. In 5% of cases, the absence of the inferior mesenteric vein was revealed. The angle of fusion of the inferior mesenteric vein with the superior mesenteric vein was statistically significantly greater than the angle of fusion of the inferior mesenteric vein with the splenic vein. The angles were 76.36 ± 1.53 ° and 64.89 ± 3.52 °, respectively (p = 0.004). The length of the common trunk of the inferior mesenteric and splenic veins was significantly greater than the common trunk of the mesenteric veins and amounted to 16.98 ± 1.09 mm and 9.37 ± 0.65 mm (p = 0.001), respectively. Thus, the study showed a high degree of anatomical variability of the inferior mesenteric vein.

Hydatid Cyst of Liver Ruptured in the Portal Vein

2020 ◽  
Author(s):  
Salah Berkane
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Portal Vein ◽  
Hydatid Cyst ◽  
Liver Cyst ◽  
Portal System ◽  
Resonance Imaging ◽  
Hydatid Cysts ◽  
The Right

Introduction: The rupture of a hydatid liver cyst in the portal system is an exceptional complication. It has been reported only few observations in the world literature. We report a case a patient that we operated on for a complicated hydatid liver cyst. Observation: This is a 46-year-old patient, a professional driver with a hunting dog hospitalized in the surgical department for obstructive jaundice. Abdominal ultrasonography, computed tomography and magnetic resonance imaging diagnosed 3 hydatid cysts in stage III of Gharbi accompanied by partial thrombosis of the portal vein with an absence of visualization of its right branch. The exploration operation revealed the existence of 3 hydatid cysts that communicate with each other and destroy half of the right liver. At the end of the total cystectomy, a communication of the cyst with the right branch of the portal vein was highlighted and the evacuation of the daughter vesicles followed by a major hemorrhage. The daughter vesicle was evacuated and the right branch of the portal vein was ligated and the bile ducts drained by a transcystic drain. The postoperative complications were complicated by a biliary fistula which dried up on the 19th postoperative day. The patient was discharged from the service on the 30th postoperative day. Currently, he is on Albendazole tablet 400mg / day with well health. Conclusion: The rupture of a hydatid cyst in the portal system remains rare and its diagnosis is well established by modern examinations such as ultrasound, computed tomography and magnetic resonance imaging. The treatment involves surgery and Albendazole but remains quite difficult.

scholarly journals Anomalies of the Portal Venous System in Dogs and Cats as Seen on Multidetector-Row Computed Tomography: An Overview and Systematization Proposal

2019 ◽  
Vol 6 (1) ◽  
pp. 10 ◽  
Author(s):  
Giovanna Bertolini
Keyword(s):  
Computed Tomography ◽  
Portal Vein ◽  
Venous System ◽  
Low Flow ◽  
Portal System ◽  
Multidetector Row Computed Tomography ◽  
Portal Venous System ◽  
Multidetector Row ◽  
Vein Thrombosis ◽  
Portosystemic Shunts

This article offers an overview of congenital and acquired vascular anomalies involving the portal venous system in dogs and cats, as determined by multidetector-row computed tomography angiography. Congenital absence of the portal vein, portal vein hypoplasia, portal vein thrombosis and portal collaterals are described. Portal collaterals are further discussed as high- and low-flow connections and categorized in hepatic arterioportal malformation, arteriovenous fistula, end-to-side and side-to-side congenital portosystemic shunts, acquired portosystemic shunts, cavoportal and porto-portal collaterals. Knowledge of different portal system anomalies helps understand the underlying physiopathological mechanism and is essential for surgical and interventional approaches.

Portomesenteric thrombosis after robotic sleeve gastrectomy

2020 ◽  
Vol 13 (12) ◽  
pp. e236202
Author(s):  
Omkaar Jaikaran ◽  
Derek Lim ◽  
Brian Binetti ◽  
Vadim Meytes
Keyword(s):  
Sleeve Gastrectomy ◽  
Portal Vein ◽  
Methylenetetrahydrofolate Reductase ◽  
Splenic Vein ◽  
Subsequent Development ◽  
Obese Women ◽  
Splenic Vein Thrombosis ◽  
Vein Thrombosis ◽  
Robotic Sleeve Gastrectomy ◽  
Compound Mutation

Portomesenteric thrombosis is an important but rarely reported complication following bariatric surgery. It has been suggested that the incidence of portal vein thrombosis is directly related to many risk factors inherent in the bariatric population as well as factors related to local and systemic effects of laparoscopic surgery. Possible aetiologies vary from systemic inherited hypercoagulable states to a direct inflammatory reaction of portosystemic vessels. Here we present a case report of a 47-year-old obese women who underwent a robotic sleeve gastrectomy with subsequent development of a main portal vein, complete right intrahepatic portal vein and splenic vein thrombosis ultimately found to have a compound mutation of the methylenetetrahydrofolate reductase C677T and A1298C alleles.

The Vascular Structure of the Kidney of Mallards and Doves

1999 ◽  
Vol 5 (S2) ◽  
pp. 1192-1193
Author(s):  
H. Ditrich
Keyword(s):  
Vascular System ◽  
Venous Drainage ◽  
Portal System ◽  
Physiological Data ◽  
Vascular Structure ◽  
Serial Sections ◽  
Functional Importance ◽  
Additional Material ◽  
Functional Studies ◽  
Primitive Feature

The architecture of the kidney of birds (and also reptiles) is, unlike in mammalians, mainly determined by the organization of the blood vascular system. Besides arterial supply and venous drainage, the renal portal system forms a main structural component. While the latter was often regarded as a “primitive” feature in the literature, morphological and physiological data reveal its great functional importance.Microvascular corrosion casts studied in the scanning electron microscope permit the visualization of minute vessels, retaining their 3D-arrangement. Additionally, when compared with graphical reconstructions of serial sections, this method avoids several inherent artifacts like fixation and dehydration shrinkage as well as the compression of the object by the sectioning blade. Most of the studies on avian kidneys with this technique used the domestic chicken as a model. In order to provide additional material for comparative and functional studies, data on the intrarenal vascular structure of other species are required.

scholarly journals Vascular Involvements in Cholangiocarcinoma: Tips and Tricks

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3735
Author(s):  
Roberta Angelico ◽  
Bruno Sensi ◽  
Alessandro Parente ◽  
Leandro Siragusa ◽  
Carlo Gazia ◽  
...  
Keyword(s):  
Portal Vein ◽  
Hepatic Artery ◽  
Vena Cava ◽  
High Volume ◽  
Vascular Reconstruction ◽  
Ex Situ ◽  
Vascular Involvement ◽  
Hepatic Veins ◽  
Hepatic Artery Resection ◽  
Artery Resection

Cholangiocarcinoma (CCA) is an aggressive malignancy of the biliary tract. To date, surgical treatment remains the only hope for definitive cure of CCA patients. Involvement of major vascular structures was traditionally considered a contraindication for resection. Nowadays, selected cases of CCA with vascular involvement can be successfully approached. Intrahepatic CCA often involves the major hepatic veins or the inferior vena cava and might necessitate complete vascular exclusion, in situ hypothermic perfusion, ex situ surgery and reconstruction with autologous, heterologous or synthetic grafts. Hilar CCA more frequently involves the portal vein and hepatic artery. Resection and reconstruction of the portal vein is now considered a relatively safe and beneficial technique, and it is accepted as a standard option either with direct anastomosis or jump grafts. However, hepatic artery resection remains controversial; despite accumulating positive reports, the procedure remains technically challenging with increased rates of morbidity. When arterial reconstruction is not possible, arterio-portal shunting may offer salvage, while sometimes an efficient collateral system could bypass the need for arterial reconstructions. Keys to achieve success are represented by accurate selection of patients in high-volume referral centres, adequate technical skills and eclectic knowledge of the various possibilities for vascular reconstruction.

scholarly journals Transsplenic portal vein recanalization and direct intrahepatic portosystemic shunt placement to optimize liver transplantation

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Osman Ahmed ◽  
Abhijit L. Salaskar ◽  
Steven Zangan ◽  
Anjana Pillai ◽  
Talia Baker
Keyword(s):  
Liver Transplantation ◽  
Portal Vein ◽  
Splenic Vein ◽  
Portosystemic Shunt ◽  
Refractory Ascites ◽  
Hepatic Veins ◽  
Sonographic Guidance ◽  
Portosystemic Shunts ◽  
Intrahepatic Portosystemic Shunt ◽  
End To End

Abstract Background Percutaneous trans-splenic portal vein recanalization (PVR) has been reported for facilitation of transjugular intrahepatic portosystemic shunts (TIPS), however has not been applied to patients undergoing direct intrahepatic portosystemic shunt (DIPS). We report the utilization of trans-splenic-PVR with DIPS creation in a patient with chronic portal and hepatic vein occlusions undergoing liver transplantation evaluation. Case presentation A 48-year-old male with decompensated alcoholic cirrhosis complicated by refractory ascites, hepatic encephalopathy, and variceal bleeding underwent CT that demonstrated chronic occlusion of the hepatic veins (HV), extrahepatic portal vein (PV), and superior mesenteric vein (SMV). Due to failed attempts at TIPS at outside institutions, interventional radiology was consulted for portal vein recanalization (PVR) with TIPS to treat the portal hypertension and ascites and also facilitate an end-to-end PV anastomosis at transplantation. After an initial hepatic venogram confirmed chronic HV occlusion, a DIPS with trans-splenic PVR was planned. The splenic vein was accessed under sonographic guidance using a micropuncture set and subsequently upsized to a 6 French sheath over a stiff guidewire. A splenic venogram via this access confirmed occlusion of the PV with drainage of the splenic vein (SV) through gastric varices. The thrombosed PV was then recanalized and angioplastied to restore PV flow via the transsplenic approach. A transjugular liver access kit with a modified 21-gauge needle was advanced into the IVC through the internal jugular vein (IJV) sheath and directed towards the target snare in PV. The needle was used to subsequently puncture the PV through the caudate lobe and facilitate placement of a wire into the SV. The initial portosystemic gradient (PSG) was 20 mmHg. The IJV sheath was advanced through the hepatic parenchymal tract into the main-PV and a stent-graft was placed across the main PV and into the IVC. A portal venogram demonstrated brisk blood flow through the DIPS, resolution of varices and a PSG of 8 mmHg. One month after the procedure, the patient had a significant reduction in ascites and MELD-NA score. Patient is currently listed and awaiting transplantation. Conclusions In the setting of chronically occluded portal and hepatic veins, trans-splenic PVR DIPS may serve as an effective bridge to liver transplantation by facilitating an end to end portal vein anastomosis.

scholarly journals Splenic Artery Embolisation for the Emergency Treatment of Sinistral Portal Hypertension: A Systematic Review

2021 ◽  
Vol 5 (02) ◽  
pp. 079-085
Author(s):  
Harriet Grout-Smith ◽  
Ozbil Dumenci ◽  
N. Paul Tait ◽  
Ali Alsafi
Keyword(s):  
Systematic Review ◽  
Portal Hypertension ◽  
Variceal Bleeding ◽  
Splenic Artery ◽  
Splenic Vein ◽  
Treatment Modalities ◽  
Portal System ◽  
Technical Success Rate ◽  
Randomized Controlled Studies ◽  
Sinistral Portal Hypertension

Abstract Objectives Sinistral portal hypertension (SPH) is caused by increased pressure on the left portal system secondary to splenic vein stenosis or occlusion and may lead to gastric varices. The definitive management of SPH is splenectomy, but this is associated with significant mortality and morbidity in the acute setting. In this systematic review, we investigated the efficacy and safety of splenic artery embolisation (SAE) in managing refractory variceal bleeding in patients with SPH. Methods A comprehensive literature search was conducted using MEDLINE and Embase databases. A qualitative analysis was chosen due to heterogeneity of the studies. Results Our search yielded 339 articles, 278 of which were unique. After initial screening, 16 articles relevant to our search remained for full text review. Of these, 7 were included in the systematic review. All 7 papers were observational, 6 were retrospective. Between them they described 29 SAE procedures to control variceal bleeding. The technical success rate was 100% and there were no cases of rebleeding during follow up. The most common complication was post-embolisation syndrome. Four major complications occurred, two resulting in death. These deaths were the only 30-day mortalities recorded and were in patients with extensive comorbidities. Conclusions Although there is a distinct lack of randomized controlled studies comparing SAE to other treatment modalities, it appears to be safe and effective in treating hemorrhage secondary to SPH.

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