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Schlitt A, Goetz A, Stroszczynski C, Zeman F, Hackl C, Schlitt HJ, Jung EM, Uller W, Hammer S. Spleno-Mesenteric Venous Blood Flow Dynamics in Adult Patients with Chronic Portal Vein Thrombosis Analyzed by Sequential CT-Spleno- and Mesenterico-Portography. Life (Basel) 2025; 15:129. [PMID: 39860069 PMCID: PMC11766813 DOI: 10.3390/life15010129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Revised: 01/14/2025] [Accepted: 01/18/2025] [Indexed: 01/27/2025] Open
Abstract
BACKGROUND Portal vein thrombosis (PVT) leads to portal hypertension (PH) with its sequelae. Computed tomography spleno-mesenterico-portography (CT-SMPG) combines sequential CT spleno-portography and CT mesenterico-portography. CT-SMPG comprehensively illustrates the venous hemodynamic changes due to PH. OBJECTIVE To assess the effects of PV confluence thrombosis (PVCT) and liver cirrhosis on venous blood flow characteristics of patients with PVT. METHOD CT-SMPG was performed in 21 patients with chronic PVT. CT-SMPG was compared to standard contrast-enhanced CT (CECT) and gastroscopy concerning the patency of splanchnic veins, varices and venous congestion. RESULTS PVCT had a significant effect on perfusion patterns: in patients without PVCT, esophageal varices (EV) and gastric varices were supplied by either the splenic vein (SV), the superior mesenteric vein (SMV), or both. In patients with PVCT, EV and gastric varices were mostly supplied by the SV (p = 0.021, p = 0.016). In patients without PVCT, small bowel varices were fed by both systems or the SMV, while in patients with PVCT they were fed by the SMV (p = 0.031). No statistically significant changes were detected regarding gastropathy, colorectal varices and small bowel congestion. Liver cirrhosis had no statistically relevant effect on hemodynamics. CONCLUSIONS In CT-SMPG, patients with PVCT showed different venous hemodynamics to patients without PVCT, and this can serve as a basis for selecting therapy options.
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Affiliation(s)
- Alexandra Schlitt
- Department of Radiology, University Medical Center Regensburg, 93053 Regensburg, Germany (C.S.); (E.-M.J.); (S.H.)
| | - Andrea Goetz
- Department of Radiology, University Medical Center Regensburg, 93053 Regensburg, Germany (C.S.); (E.-M.J.); (S.H.)
| | - Christian Stroszczynski
- Department of Radiology, University Medical Center Regensburg, 93053 Regensburg, Germany (C.S.); (E.-M.J.); (S.H.)
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Christina Hackl
- Department of Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (C.H.); (H.J.S.)
| | - Hans J. Schlitt
- Department of Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (C.H.); (H.J.S.)
| | - Ernst-Michael Jung
- Department of Radiology, University Medical Center Regensburg, 93053 Regensburg, Germany (C.S.); (E.-M.J.); (S.H.)
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Simone Hammer
- Department of Radiology, University Medical Center Regensburg, 93053 Regensburg, Germany (C.S.); (E.-M.J.); (S.H.)
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Cheng W, Wang KY, Li WQ, Li Y, Li XY, Ju S. CT-based nomogram predicts esophageal gastric variceal bleeding in noncirrhotic portal hypertension caused by hepatic schistosomiasis. BMC Med Inform Decis Mak 2025; 25:8. [PMID: 39773170 PMCID: PMC11708042 DOI: 10.1186/s12911-024-02777-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 11/19/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND To construct a nomogram combining CT varices vein evaluation and clinical laboratory tests for predicting the risk of esophageal gastric variceal bleeding (EGVB) in patients with noncirrhotic portal hypertension (NCPH). METHODS A total of 315 NCPH patients with non-EGVB and EGVB were retrospectively enrolled and randomly divided into training and testing cohorts. Thirteen collateral vessels were identified and evaluated after CT portal vein system reconstruction. Multivariate binary logistic regression analysis was used to choose CT images and clinical predictors of EGVB. The varices score of each patient was calculated. A nomogram was built by combining the varices score with the selected clinical predictors of EGVB. The receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of the nomogram. RESULTS Platelet count and prothrombin time were selected as clinical predictors; the esophageal vein, gastroepiploic vein and omental vein were selected as CT image predictors for predicting EGVB. A reduced platelet count, prolonged prothrombin time, severe esophageal and gastroepiploic vein tortuosity and less omental vein tortuosity were predictors of EGVB in NCPH patients. The specificity, sensitivity, negative predictive value, positive predictive value and AUC of the ROC of the nomogram were 0.82, 0.81, 0.89, 0.70, and 0.88 (95% CI: 0.84-0.93) in the training cohort and 0.87, 0.86, 0.88, 0.84, and 0.91 (95% CI: 0.84-0.97) in the testing cohort, respectively. CONCLUSIONS The nomogram combining CT images and clinical predictors could be useful to individualize and predict the risk of EGVB in NCPH patients. CLINICAL RELEVANCE STATEMENT Results showed that the nomogram combining CT-evaluated collateral vessels (varices score) and clinical laboratory tests could be used to realize personalized prediction of first-time EGVB in NCPH patients.
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Affiliation(s)
- Wei Cheng
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, 201508, China
| | - Ke-Ying Wang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, 201508, China
| | - Wen-Qiang Li
- Department of Vascular and Wound Center, Jinshan Hospital, Fudan University, Shanghai, 201508, China
| | - Yao Li
- Department of Vascular and Wound Center, Jinshan Hospital, Fudan University, Shanghai, 201508, China
| | - Xiao-Yan Li
- Department of Vascular and Wound Center, Jinshan Hospital, Fudan University, Shanghai, 201508, China
| | - Shuai Ju
- Department of Vascular and Wound Center, Jinshan Hospital, Fudan University, Shanghai, 201508, China.
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Barr RG. Multiparametric Ultrasound for Chronic Liver Disease. Radiol Clin North Am 2025; 63:13-28. [PMID: 39510657 DOI: 10.1016/j.rcl.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2024]
Abstract
Diffuse liver disease is a substantial world-wide problem. With the combination of conventional ultrasound of the abdomen, fat quantification and elastography, appropriate staging of the patient can be assessed. This information allows for the diagnosis of steatosis and detection of fibrosis as well as prognosis, surveillance, and prioritization for treatment. With the potential for reversibility with appropriate treatment accurate assessment for the stage of chronic liver disease is critical.
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Affiliation(s)
- Richard G Barr
- Northeastern Ohio Medical University, Southwoods Imaging, 7623 Market Street, Youngstown, OH 44512, USA.
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Dragomir I, Pojoga C, Hagiu C, Seicean R, Procopet B, Seicean A. Endoscopic ultrasound in portal hypertension: navigating venous hemodynamics and treatment efficacy. Gastroenterol Rep (Oxf) 2024; 12:goae082. [PMID: 39281269 PMCID: PMC11398876 DOI: 10.1093/gastro/goae082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/23/2024] [Accepted: 06/07/2024] [Indexed: 09/18/2024] Open
Abstract
Portal hypertension-related complications increase mortality in patients, irrespective of its etiology. Classically, endoscopic ultrasound (EUS) was used to assess the portal venous system and collaterals, considering size and hemodynamic parameters, which correlate with portal hypertension (PH) and related complications. Furthermore, therapeutic EUS guides treatment interventions, such as embolization of the gastric varices through coil placement and tissue adhesive injection, yielding encouraging clinical results. Recently, the direct measurement of portal pressure, emerging as an alternative to hepatic venous pressure gradient, has shown promise, and further research in this area is anticipated. In this review, we aimed to provide a detailed description of various possibilities for diagnosing vascular anatomy and hemodynamics in PH and actual knowledge on the EUS usefulness for PH vessel-related complications. Also, future promises for this field of endo-hepatology are discussed.
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Affiliation(s)
- Irina Dragomir
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj Napoca, Romania
- Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, Cluj Napoca, Romania
| | - Cristina Pojoga
- Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, Cluj Napoca, Romania
- UBB Med, Babeş-Bolyai University, Department of Clinical Psychology and Psychotherapy, International Institute for Advanced Study of Psychotherapy and Applied Mental Health, Cluj Napoca, Romania
| | - Claudia Hagiu
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj Napoca, Romania
- Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, Cluj Napoca, Romania
| | - Radu Seicean
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj Napoca, Romania
- First Surgical Clinic, County Emergency Hospital, Cluj Napoca, Romania
| | - Bogdan Procopet
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj Napoca, Romania
- Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, Cluj Napoca, Romania
| | - Andrada Seicean
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj Napoca, Romania
- Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, Cluj Napoca, Romania
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Iranmanesh M, Sato AF, Tenney W, Brinker EJ, Cortez K, Mazan M. Computed tomographic angiography of a presumed acquired transhepatic portosystemic shunt in a miniature horse filly. Vet Radiol Ultrasound 2024; 65:590-595. [PMID: 38940068 DOI: 10.1111/vru.13401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 04/14/2024] [Accepted: 06/03/2024] [Indexed: 06/29/2024] Open
Abstract
A 1-year-old Miniature Horse filly was presented for chronic lethargy and hyporexia. Elevated liver enzymes, bile acids, and ammonia were noted on bloodwork. The primary differential diagnosis was a portosystemic shunt (PSS). Three-phase computed tomographic angiography findings were consistent with a transhepatic portosystemic shunt. Percutaneous liver biopsy confirmed severe diffuse hepatic changes, most likely due to chronic pyrrolizidine alkaloid toxicosis, and medical management was elected. Based on an extensive literature review, this is the first report of a transhepatic portosystemic collateral vessel in a horse. Computed tomographic angiography is feasible and useful for the diagnosis of PSS in miniature horses.
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Affiliation(s)
- Maryam Iranmanesh
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - Amy F Sato
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - Wade Tenney
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - Emily J Brinker
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - Keaton Cortez
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - Melissa Mazan
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
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Jung JC, Park SY, Kim KD, Shin WY, Lee KY. Evolution of splenomegaly in liver cirrhosis: Simulation using an electronic circuit. Adv Med Sci 2024; 69:377-384. [PMID: 39117272 DOI: 10.1016/j.advms.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/19/2024] [Accepted: 08/05/2024] [Indexed: 08/10/2024]
Abstract
PURPOSE The evolution of splenomegaly in patients with liver cirrhosis remains largely unknown. In this study, we followed the changes in splenic volume and established the natural course of splenomegaly. We developed an electronic circuit that simulated splenoportal circulation and identified the underlying hemodynamic mechanisms. MATERIALS AND METHODS This retrospective observational study included 93 patients with cirrhosis. Splenic volumes were measured in imaging studies at 6-month intervals and normalized by the ratio of each patient's maximum volume during follow-up (%Vmax). An electronic simulation model was constructed using software and realized on a breadboard. RESULTS Overall, the %Vmax increased from 0.77 ± 0.21 to a maximum of 1.00 ± 0.00 (p < 0.001) during a median follow-up of 23 (3-162) months and then decreased to 0.84 ± 0.18 (p < 0.001) during the next 9 (3-132) months. No interventional radiology procedure was performed to improve hepatic fibrosis and portal hypertension. The evolution of %Vmax showed single-peaked symmetry. An electronic simulation model showed that the upslope of the evolution curve was dependent on the increased intrahepatic vascular resistance and portal hypertension, whereas the downslope was dependent on the decreased portosystemic shunt (PSS) resistance. CONCLUSIONS Splenomegaly in cirrhotic patients aggravated over a period of 23 months and then regressed spontaneously to its initial volume. Electronic simulation of splenoportal circulation showed that splenic enlargement was due to the advancement of liver cirrhosis and portal hypertension, whereas its regression was due to the development of a PSS.
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Affiliation(s)
- Jae Cheol Jung
- Department of Surgery, Inha University School of Medicine, Incheon, Republic of Korea
| | - Shin-Young Park
- Department of Surgery, Inha University School of Medicine, Incheon, Republic of Korea
| | - Kyeong Deok Kim
- Department of Surgery, Inha University School of Medicine, Incheon, Republic of Korea
| | - Woo Young Shin
- Department of Surgery, Inha University School of Medicine, Incheon, Republic of Korea
| | - Keon-Young Lee
- Department of Surgery, Inha University School of Medicine, Incheon, Republic of Korea.
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Wikström MB, Stene-Hurtsén A, Åström J, Hörer TM, Nilsson KF. The effect of an endovascular Heaney maneuver to achieve total hepatic isolation on survival, hemodynamic stability, retrohepatic bleeding, and collateral flow in a porcine model. Eur J Trauma Emerg Surg 2024; 50:1547-1557. [PMID: 38456908 PMCID: PMC11458705 DOI: 10.1007/s00068-024-02482-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/19/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE Combining resuscitative endovascular balloon occlusion of the aorta (REBOA) and the inferior vena cava (REBOVC) with open surgery is a new hybrid approach for treating retrohepatic vena caval injuries. We compared endovascular total hepatic isolation with supraceliac REBOA ± suprahepatic REBOVC and no occlusion in experimental retrohepatic vena cava bleeding regarding survival, bleeding volume, hemodynamic stability, and arterial collateral blood flow. METHODS Twenty-five anesthetized pigs (n = 6-7/group) were randomized to REBOA; REBOA + REBOVC; REBOA + infra and suprahepatic REBOVC + portal vein occlusion (endovascular Heaney maneuver, four-balloon-occlusion, 4BO) or no occlusion. After balloon inflation, free bleeding was initiated from an open sheath in the retrohepatic vena cava. Bleeding volume, right internal thoracic artery (RITA) blood flow, hemodynamics, and arterial blood variables were measured until death or up to 90 min. RESULTS The REBOA group had a longer median survival time (63 min) compared with the 4BO (24 min, P = 0.02) and no occlusion (30 min, P = 0.02) groups, not versus the REBOA + REBOVC group (49 min, P > 0.05). The first 15 min accumulated bleeding was comparable in all groups (P > 0.05); Thereafter, bleeding volume was higher in the REBOA group versus the 4BO group (P < 0.05), not versus the other groups. RITA blood flow and MAP were higher in the REBOA group versus the other groups after 10 min of bleeding (P < 0.05). CONCLUSIONS Endovascular Heaney maneuver was not beneficial for survival or hemodynamic stability in this porcine model, whereas supraceliac REBOA was. Anatomical differences in thoracoabdominal collaterals between pigs and humans must be considered when interpreting these results.
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Affiliation(s)
- Maria B Wikström
- Department of Emergency, Arvika Hospital, Region Värmland, Arvika, Sweden.
- School of Medical Sciences, Örebro University, Örebro, Sweden.
| | - Anna Stene-Hurtsén
- School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Cardiothoracic and Vascular Surgery, Department of Surgery, Örebro University Hospital and Faculty of Medicine and Health, Örebro University, Örebro, Region Örebro Län, Sweden
| | - Jens Åström
- Department of Anesthesiology and Intensive Care, Falun Hospital, Falun, Region Dalarna, Sweden
| | - Tal M Hörer
- Department of Cardiothoracic and Vascular Surgery, Department of Surgery, Örebro University Hospital and Faculty of Medicine and Health, Örebro University, Örebro, Region Örebro Län, Sweden
| | - Kristofer F Nilsson
- School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Cardiothoracic and Vascular Surgery, Department of Surgery, Örebro University Hospital and Faculty of Medicine and Health, Örebro University, Örebro, Region Örebro Län, Sweden
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Juncu S, Minea H, Girleanu I, Huiban L, Muzica C, Chiriac S, Timofeiov S, Mihai F, Cojocariu C, Stanciu C, Trifan A, Singeap AM. Clinical Implications and Management of Spontaneous Portosystemic Shunts in Liver Cirrhosis. Diagnostics (Basel) 2024; 14:1372. [PMID: 39001262 PMCID: PMC11241716 DOI: 10.3390/diagnostics14131372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
Portal hypertension from chronic liver disease leads to the formation of collateral blood vessels called spontaneous portosystemic shunts (SPSS). These shunts may form from existing vessels or through neo-angiogenesis. Their location affects clinical outcomes due to varying risks and complications. This review summarizes current knowledge on SPSS, covering their clinical impact and management strategies. Recent data suggest that SPSS increases the risk of variceal bleeding, regardless of shunt size. The size of the shunt is crucial in the rising incidence of hepatic encephalopathy (HE) linked to SPSS. It also increases the risk of portopulmonary hypertension and portal vein thrombosis. Detecting and assessing SPSS rely on computed tomography (CT) and magnetic resonance imaging. CT enables precise measurements and the prediction of cirrhosis progression. Management focuses on liver disease progression and SPSS-related complications, like HE, variceal bleeding, and portopulmonary hypertension. Interventional radiology techniques such as balloon-occluded, plug-assisted, and coil-assisted retrograde transvenous obliteration play a pivotal role. Surgical options are rare but are considered when other methods fail. Liver transplantation (LT) often resolves SPSS. Intraoperative SPSS ligation is still recommended in patients at high risk for developing HE or graft hypoperfusion.
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Affiliation(s)
- Simona Juncu
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Universitatii Street No. 16, 700115 Iasi, Romania; (S.J.); (H.M.); (I.G.); (L.H.); (C.M.); (C.C.); (C.S.); (A.T.); (A.-M.S.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency County Hospital, Bd. Independentei No. 1, 700111 Iasi, Romania
| | - Horia Minea
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Universitatii Street No. 16, 700115 Iasi, Romania; (S.J.); (H.M.); (I.G.); (L.H.); (C.M.); (C.C.); (C.S.); (A.T.); (A.-M.S.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency County Hospital, Bd. Independentei No. 1, 700111 Iasi, Romania
| | - Irina Girleanu
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Universitatii Street No. 16, 700115 Iasi, Romania; (S.J.); (H.M.); (I.G.); (L.H.); (C.M.); (C.C.); (C.S.); (A.T.); (A.-M.S.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency County Hospital, Bd. Independentei No. 1, 700111 Iasi, Romania
| | - Laura Huiban
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Universitatii Street No. 16, 700115 Iasi, Romania; (S.J.); (H.M.); (I.G.); (L.H.); (C.M.); (C.C.); (C.S.); (A.T.); (A.-M.S.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency County Hospital, Bd. Independentei No. 1, 700111 Iasi, Romania
| | - Cristina Muzica
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Universitatii Street No. 16, 700115 Iasi, Romania; (S.J.); (H.M.); (I.G.); (L.H.); (C.M.); (C.C.); (C.S.); (A.T.); (A.-M.S.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency County Hospital, Bd. Independentei No. 1, 700111 Iasi, Romania
| | - Stefan Chiriac
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Universitatii Street No. 16, 700115 Iasi, Romania; (S.J.); (H.M.); (I.G.); (L.H.); (C.M.); (C.C.); (C.S.); (A.T.); (A.-M.S.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency County Hospital, Bd. Independentei No. 1, 700111 Iasi, Romania
| | - Sergiu Timofeiov
- Department of Surgery, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Universitatii Street No. 16, 700115 Iasi, Romania;
- Department of Surgery, “St. Spiridon” Emergency County Hospital, Bd. Independentei No. 1, 700111 Iasi, Romania
| | - Florin Mihai
- Department of Radiology and Medical Imaging, “Grigore T. Popa” University of Medicine and Pharmacy, Universitatii Street No. 16, 700115 Iasi, Romania
| | - Camelia Cojocariu
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Universitatii Street No. 16, 700115 Iasi, Romania; (S.J.); (H.M.); (I.G.); (L.H.); (C.M.); (C.C.); (C.S.); (A.T.); (A.-M.S.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency County Hospital, Bd. Independentei No. 1, 700111 Iasi, Romania
| | - Carol Stanciu
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Universitatii Street No. 16, 700115 Iasi, Romania; (S.J.); (H.M.); (I.G.); (L.H.); (C.M.); (C.C.); (C.S.); (A.T.); (A.-M.S.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency County Hospital, Bd. Independentei No. 1, 700111 Iasi, Romania
| | - Anca Trifan
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Universitatii Street No. 16, 700115 Iasi, Romania; (S.J.); (H.M.); (I.G.); (L.H.); (C.M.); (C.C.); (C.S.); (A.T.); (A.-M.S.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency County Hospital, Bd. Independentei No. 1, 700111 Iasi, Romania
| | - Ana-Maria Singeap
- Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Universitatii Street No. 16, 700115 Iasi, Romania; (S.J.); (H.M.); (I.G.); (L.H.); (C.M.); (C.C.); (C.S.); (A.T.); (A.-M.S.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency County Hospital, Bd. Independentei No. 1, 700111 Iasi, Romania
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Hien PN, Chun HJ, Kim SH. Transarterial chemoembolization for omental vein tumor thrombosis in hepatocellular carcinoma: a case report. J Gastrointest Oncol 2024; 15:794-799. [PMID: 38756637 PMCID: PMC11094509 DOI: 10.21037/jgo-24-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/08/2024] [Indexed: 05/18/2024] Open
Abstract
Background In hepatocellular carcinoma (HCC) patients, recognizing major vascular invasions such as portal vein tumor thrombosis (PVTT) and hepatic vein tumor thrombosis (HVTT) is crucial for disease staging. Less documented is the invasion of other vessels. We report a case of omental vein tumor thrombosis (OVTT) in an HCC patient treated with transarterial chemoembolization (TACE). Case Description A 74-year-old male patient with hepatitis B infection was diagnosed with HCC in segment 8 five years ago and treated with radiofrequency ablation (RFA). The tumor recurred at the ablation site, measuring 25 mm × 18 mm, invading the portal vein branch of the posterior segment and a omental vein, showing tumor thrombosis. The patient received TACE targeting branches from the right hepatic artery and omental artery. After two TACE sessions, the tumor and thrombosis completely responded, and tumor markers returned to normal. Conclusions This case report highlights the uncommon presentation of OVTT alongside PVTT in advanced HCC, emphasizing the need for vigilance in diagnosing atypical disease progressions in HCC and a possible treatment efficacy of TACE.
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Affiliation(s)
- Phan Nhan Hien
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Radiology Centre, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Ho Jong Chun
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Su Ho Kim
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Oyama H, Takahashi Y, Minegishi Y, Nakamura A, Tanaka K. Jejunal vein tributary analysis and intraoperative clamp testing in avoiding congestion after pancreatoduodenectomy. Langenbecks Arch Surg 2024; 409:79. [PMID: 38427063 DOI: 10.1007/s00423-024-03276-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/27/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Although venous drainage of the jejunal loop may be maintained after sacrifice of jejunal vein tributaries during pancreatoduodenectomy, risk of severe jejunal mesenteric congestion following division of these tributaries can be difficult to predict. This study considered how best to predict safety of jejunal vein tributary dissection. METHODS Preoperative imaging findings and results of intraoperative clamp tests of jejunal vein tributaries during pancreatoduodenectomy were analyzed in 121 patients with hepatobiliary and pancreatic disease to determine whether this information adequately predicted safety of resecting superior mesenteric vein branches. RESULTS Jejunal vein tributaries caudal to the inferior border of the pancreatic uncinate process tended to be fewer when tributaries cranial to this landmark were more numerous. Tributaries cranial to the border drained a relatively wide expanse of jejunal artery territory in the jejunal mesentery. The territory of jejunal tributaries cranial to the inferior border of the pancreas did not vary according to course of the first jejunal vein branch relative to the superior mesenteric artery. One patient among 30 (3%) who underwent intraoperative clamp tests of tributaries cranial to the border showed severe congestion in relation to a venous tributary coursing ventrally to the superior mesenteric artery. CONCLUSION Jejunal venous tributaries drained an extensive portion of jejunal arterial territory, but tributaries located cranially to the inferior border of the pancreas could be sacrificed without congestion in nearly all patients. Intraoperative clamp testing of these tributaries can identify patients whose jejunal veins must be preserved to avoid congestion.
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Affiliation(s)
- Hideyuki Oyama
- Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan
| | - Yuki Takahashi
- Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan
| | - Yuzo Minegishi
- Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan
| | - Akihiro Nakamura
- Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan
| | - Kuniya Tanaka
- Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan.
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11
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Wong YW, Haqqani H, Molenaar P. Roles of β-adrenoceptor Subtypes and Therapeutics in Human Cardiovascular Disease: Heart Failure, Tachyarrhythmias and Other Cardiovascular Disorders. Handb Exp Pharmacol 2024; 285:247-295. [PMID: 38844580 DOI: 10.1007/164_2024_720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
β-Adrenoceptors (β-ARs) provide an important therapeutic target for the treatment of cardiovascular disease. Three β-ARs, β1-AR, β2-AR, β3-AR are localized to the human heart. Activation of β1-AR and β2-ARs increases heart rate, force of contraction (inotropy) and consequently cardiac output to meet physiological demand. However, in disease, chronic over-activation of β1-AR is responsible for the progression of disease (e.g. heart failure) mediated by pathological hypertrophy, adverse remodelling and premature cell death. Furthermore, activation of β1-AR is critical in the pathogenesis of cardiac arrhythmias while activation of β2-AR directly influences blood pressure haemostasis. There is an increasing awareness of the contribution of β2-AR in cardiovascular disease, particularly arrhythmia generation. All β-blockers used therapeutically to treat cardiovascular disease block β1-AR with variable blockade of β2-AR depending on relative affinity for β1-AR vs β2-AR. Since the introduction of β-blockers into clinical practice in 1965, β-blockers with different properties have been trialled, used and evaluated, leading to better understanding of their therapeutic effects and tolerability in various cardiovascular conditions. β-Blockers with the property of intrinsic sympathomimetic activity (ISA), i.e. β-blockers that also activate the receptor, were used in the past for post-treatment of myocardial infarction and had limited use in heart failure. The β-blocker carvedilol continues to intrigue due to numerous properties that differentiate it from other β-blockers and is used successfully in the treatment of heart failure. The discovery of β3-AR in human heart created interest in the role of β3-AR in heart failure but has not resulted in therapeutics at this stage.
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Affiliation(s)
- Yee Weng Wong
- Cardiovascular Molecular & Therapeutics Translational Research Group, Northside Clinical School of Medicine, University of Queensland, The Prince Charles Hospital, Chermside, QLD, Australia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Haris Haqqani
- Cardiovascular Molecular & Therapeutics Translational Research Group, Northside Clinical School of Medicine, University of Queensland, The Prince Charles Hospital, Chermside, QLD, Australia
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Peter Molenaar
- Cardiovascular Molecular & Therapeutics Translational Research Group, Northside Clinical School of Medicine, University of Queensland, The Prince Charles Hospital, Chermside, QLD, Australia.
- Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
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12
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Haskal ZJ, Mohammed X, Koppula R. Transjugular Intrahepatic Portosystemic Shunt (TIPS) and Portal Hypertension. IR PLAYBOOK 2024:515-523. [DOI: 10.1007/978-3-031-52546-9_42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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13
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Chooklin S, Chuklin S, Chukla R. Ectopic varices: anatomical features for surgeons and interventional radiologists. EMERGENCY MEDICINE 2023; 19:299-311. [DOI: 10.22141/2224-0586.19.5.2023.1605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Ectopic varices are defined as dilated portosystemic collateral veins located in unusual sites, other than the gastroesophageal region. They develop secondary to portal hypertension, surgical procedures, anomalies in venous outflow, or abdominal vascular thrombosis and may be familial. Ectopic varices represent a clinical challenge because they are difficult to localize. Missing or misinterpreting these lesions can have serious consequences, and treatment options are unclear. Ectopic varices may be detected during panendoscopy, enteroscopy, endoscopic ultrasound, wireless capsule endoscopy, diagnostic angiography, multislice helical computed tomography, magnetic resonance angiography, color Doppler flow imaging, laparotomy, laparoscopy and occasionally during autopsy. They can be an important cause of bleeding and hepatic encephalopathy, so radiologists must effectively identify them to assist in making therapeutic decisions. Knowledge of the anatomy and course of these unusual portosystemic collaterals is also important for interventional radiologists and surgeons as it helps avoid inadvertent vascular damage during invasive procedures. In this article, we explore the parts of the gastrointestinal tract and organs that may be involved in ectopic varices. Literature search was conducted in the MedLine database on the PubMed platform.
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14
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Alangari A, Alamri M, Semaan T, Hafez I, Alruzug I. Varicocele Secondary to Splenic Vein Compression by Intragastric Balloon. ACG Case Rep J 2023; 10:e01155. [PMID: 37736357 PMCID: PMC10511032 DOI: 10.14309/crj.0000000000001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/18/2023] [Indexed: 09/23/2023] Open
Abstract
Intragastric balloons (IGBs) are commonly used for weight loss by mechanically distending the stomach. We present a case of a 35-year-old man who developed a left-sided varicocele 1 week after IGB insertion. Imaging revealed splenic vein compression and possible thrombosis. Urgent removal of the balloon was performed. After 1 week from removal, the patient showed significant improvement, with complete splenic vein recanalization. This case highlights the importance of early recognition of a rare complication of IGBs to avoid severe outcomes. To our knowledge, this is the first reported case linking IGBs to splenic vein compression and varicocele.
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Affiliation(s)
- Abdulrahman Alangari
- Department of Gastroenterology and Hepatology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
- Department of Gastroenterology and Hepatology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Musab Alamri
- Department of Radiology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Toufic Semaan
- Department of Gastroenterology and Hepatology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ihab Hafez
- Department of Gastroenterology and Hepatology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ibrahim Alruzug
- Department of Gastroenterology and Hepatology, King Saud Medical City, Riyadh, Saudi Arabia
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15
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Fundora Y, Hessheimer AJ, Fondevila C. Reply to: "Reconstruction for complex portal vein thrombosis - Anatomical if possible". J Hepatol 2023; 79:e131-e133. [PMID: 37328070 DOI: 10.1016/j.jhep.2023.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Yiliam Fundora
- General & Digestive Surgery Service, Hospital Clínic, Barcelona, Spain
| | - Amelia J Hessheimer
- General & Digestive Surgery Service, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Constantino Fondevila
- General & Digestive Surgery Service, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.
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16
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Kalinin DS, Khoronko YV, Sapronova NG, Stagniev DV. Variants of venous outflow from liver, esophagus and stomach in portal hypertension. ANNALY KHIRURGICHESKOY GEPATOLOGII = ANNALS OF HPB SURGERY 2023; 28:88-94. [DOI: 10.16931/1995-5464.2023-2-88-94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Affiliation(s)
- D. S. Kalinin
- Rostov State Medical University of the Ministry of Health of Russia
| | - Yu. V. Khoronko
- Rostov State Medical University of the Ministry of Health of Russia
| | - N. G. Sapronova
- Rostov State Medical University of the Ministry of Health of Russia
| | - D. V. Stagniev
- Rostov State Medical University of the Ministry of Health of Russia
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17
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Gupta A, Gamangatti S, Sharma S, Gopi S, Hemachandran N, Saraya A. Aberrant Collaterals in Cirrhosis and Challenges in its Management. J Clin Exp Hepatol 2023; 13:542-546. [PMID: 37250884 PMCID: PMC10213843 DOI: 10.1016/j.jceh.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/28/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022] Open
Abstract
Portosystemic collateral formation in cirrhotic patients plays an essential role in the natural history of patients. A thorough understanding of collateral anatomy and hemodynamics in cirrhosis, it is important to envisage diagnosis and outcomes of portal hypertension. The understanding of the patterns of aberrant portosystemic collateral channels has important implications both for the clinician and the interventionist. In this case report, our patient presented to us with the formation of aberrant collaterals at the site of subcostal hernia for which he underwent a mesh repair eight years back. The technical challenges in the management of shunt closure of these aberrant collaterals were discussed.
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Affiliation(s)
- Anany Gupta
- Department of Gastroenterology & HNU, New Delhi 110029, India
| | - Shivanand Gamangatti
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Sanchit Sharma
- Department of Gastroenterology & HNU, New Delhi 110029, India
| | - Srikanth Gopi
- Department of Gastroenterology & HNU, New Delhi 110029, India
| | - Naren Hemachandran
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Anoop Saraya
- Department of Gastroenterology & HNU, New Delhi 110029, India
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18
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Solaiman SA, Habba MR, El Kammash TH, Serwah AHA. Computed tomography predictors of gastroesophageal varices in cirrhotic patients: the added value of portosystemic collaterals. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2023; 54:64. [DOI: 10.1186/s43055-023-01016-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/01/2023] [Indexed: 01/04/2025] Open
Abstract
Abstract
Background
Detection of ‘spontaneous’ portosystemic collateral veins (PSCV) serves as an important tool in diagnosing portal hypertension (PTHN) and predicting prognosis. Multidetector computed tomography (MDCT) imaging is noninvasive and allows accurate assessment of variceal site and size. So, this study was conducted to assess the role of MDCT in predicting, detecting and grading gastroesophageal varices in correlation with endoscopy in cirrhotic patients in relation to other portosystemic collaterals.
Methods
Analytical cross-sectional prospective study was conducted on 100 cirrhotic patients. All patients were subjected to history taking, upper gastrointestinal endoscopic assessment, and triphasic CT or contrast-enhanced CT assessment of abdomen and pelvis.
Results
Patients who had esophageal varices in MDCT show a statistically significant difference (p = 0.016) with its endoscopic grading. There was good agreement between endoscopy and MDCT in diagnosing grade of esophageal varices as k = 0.882. The presence of ascites, splenic size, and esophageal vein diameter serve as clinically significant predictors of esophageal varices. Splenic size showed a significant difference according to endoscopic grades of EV (esophageal varices) as p = 0.031 as patients with no varices had splenic size of (15.9 ± 1.4) cm, patients with grade I had a mean splenic size of (15.2 ± 8.7) cm, patients with grade II had mean splenic size of (16.9 ± 1.8) cm and patients with grade III had mean splenic size of (18 ± 4.2) cm, while other veins diameters showed increase with advanced grades of EV but with statistically insignificant differences as p > 0.05.
Conclusions
Multidetector CT features of the presence of PSCVs, splenic size, and ascites are accurate predictors of PTHN in either EVs presence or absence. MDCT can be an excellent alternative for patients who are contraindicated for endoscopy. Moreover, it can be potential screening tool for early detection of esophageal varices in very early stage of chronic liver disease and in the early care of patient with varices. MDCT remains the most applicable noninvasive diagnostic tool for patients with portosystemic collaterals.
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19
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Chooklin SM, Chuklin SS. Esophageal and stomach varices: physiological and anatomical features of formation. KLINICHESKAIA KHIRURGIIA 2022. [DOI: 10.26779/2522-1396.2022.7-8.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Esophageal and stomach varices: physiological and anatomical features of formation
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20
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Pas M, Jogo A, Yamamoto A, Nishida N, Jogo E, Kageyama K, Sohgawa E, Miki Y. Successful treatment of rectal varices with antegrade transvenous sclerotherapy via the splenorenal shunt from the transjugular approach. Radiol Case Rep 2022; 17:4679-4684. [PMID: 36204409 PMCID: PMC9530408 DOI: 10.1016/j.radcr.2022.08.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 08/25/2022] [Indexed: 02/07/2023] Open
Abstract
A 74-year-old patient presented with hematochezia and a history of liver cirrhosis with repeated bleeding from esophageal and rectal varices. Endoscopic examination revealed multiple rectal varices with positive red color signs. Ascites, severe portosystemic thrombosis and a splenorenal shunt were diagnosed on a contrast-enhanced dynamic computed tomography examination. From a transjugular approach, we circumvented thrombosed regions by maneuvering double balloon catheters through the shunt and dilated left colic marginal vein. We managed to successfully obliterate the varices.
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21
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Morphometric assessment of the left inferior phrenic vein in patients with portal hypertension. Sci Rep 2022; 12:15275. [PMID: 36088466 PMCID: PMC9464207 DOI: 10.1038/s41598-022-19610-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 08/31/2022] [Indexed: 11/08/2022] Open
Abstract
The left inferior phrenic vein (LIPV) is a major drainage vessel of gastric varices and serves as an important conduit in endovascular treatment for gastric varices. The narrowing of LIPV has been empirically demonstrated and sometimes hinders catheter insertion for the treatment of gastric varices. We herein investigated the morphology of narrowed LIPV in patients with portal hypertension. Venograms of LIPV on 25 patients with gastric varices (15 males; 10 females; age range, 45–79 years with a mean of 67 years) were retrospectively reviewed, the following four parameters were measured: the diameter of LIPV, the diameter of narrowed LIPV, the narrowing rate, and the distance to narrowed LIPV from the left renal vein. On all 25 venograms, a narrowing was detected just above the common trunk with the left adrenal vein. The diameter of LIPV was 9.0 ± 4.2 mm, the diameter of narrowed LIPV was 5.1 ± 2.3 mm, the narrowing rate was 40.6 ± 16.0%, and the distance to narrowed LIPV from the left renal vein was 20.0 ± 7.4 mm. This anatomical information about the narrowing of LIPV may contribute to the safe and efficacious treatment of gastric varices.
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22
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Efficient Initial Eradication of Large Esophageal Varices by Balloon-compression Endoscopic Injection Sclerotherapy. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2022; 32:571-576. [PMID: 36044334 DOI: 10.1097/sle.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The management of large esophageal varices (EVs) remains challenging because of the difficulty of endoscopic variceal ligation and fatal post-endoscopic variceal ligation bleeding ulcers. The current study evaluated the efficacy and safety of balloon-compression endoscopic injection sclerotherapy (bc-EIS) in the treatment of large EVs. MATERIALS AND METHODS This retrospective study included 105 patients with cirrhosis exhibiting large EVs (64 in the bc-EIS group and 41 in the EIS group). Primary outcomes included the initial rate of variceal eradication and intraoperative bleeding signs. Secondary outcomes included incidences of rebleeding, mortality, complications, and optimal time of balloon-compression (bc). RESULTS The initial rate of variceal eradication in the bc-EIS group was significantly higher than that in the EIS group (46.9 vs. 24.4%; P=0.021). The incidence of intraoperative bleeding, which was represented as oozing and spurting, in the bc-EIS group was markedly lower than that in the EIS group (43.8 vs. 61.0% and 9.4 vs. 39.0%, respectively; P=0.043). Patients in the bc-EIS group showed a significantly lower incidence of rebleeding (0.0 vs. 17.1%; P=0.001). However, no significant difference in mortality rate was observed between different groups. Chest pain or discomfort tended to be more common in the EIS group than in the bc-EIS group (58.5 vs. 17.2%; P=0.001). The cut-off value of 11.5-minutes appeared to have a maximum combined sensitivity and specificity of 80.0% and 58.8%, respectively. The area under the curve was 0.708 (95% confidence interval =0.576-0.839; P=0.004). CONCLUSION bc-EIS could achieve a higher variceal eradication rate and milder intraoperative bleeding signs in large EVs. Furthermore, 11.5-minutes appeared to be the optimal compression time in bc-EIS.
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23
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Zurcher KS, Staack SO, Spencer EB, Liska A, Alzubaidi SJ, Patel IJ, Naidu SG, Oklu R, Dymek RA, Knuttinen MG. Venous Anatomy and Collateral Pathways of the Pelvis: An Angiographic Review. Radiographics 2022; 42:1532-1545. [PMID: 35867595 DOI: 10.1148/rg.220012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The pelvic venous system is complex, with the potential for numerous pathways of collateralization. Owing to stenosis or occlusion, both thrombotic and nonthrombotic entities in the pelvis may necessitate alternate routes of venous return. Although the pelvic venous anatomy and collateral pathways may demonstrate structural variability, a number of predictable paths often can be demonstrated on the basis of the given disease and the level of obstruction. Several general categories of collateral pathways have been described. These pathway categories include the deep pathway, which is composed of the lumbar and sacral veins and vertebral venous plexuses; the superficial pathway, which is composed of the circumflex and epigastric vessels; various iliofemoral collateral pathways; the intermediate pathway, which is composed of the gonadal veins and the ovarian and uterine plexuses; and portosystemic pathways. The pelvic venous anatomy has been described in detail in cadaveric and anatomic studies, with the aforementioned collateral pathways depicted on CT and MR images in several imaging studies. A comprehensive review of the native pelvic venous anatomy and collateralized pelvic venous anatomy based on angiographic features has yet to be provided. Knowledge of the diseases involving a number of specific pelvic veins is of clinical importance to interventional and diagnostic radiologists and surgeons. The ability to accurately identify common collateral patterns by using multiple imaging modalities, with accurate anatomic descriptions, may assist in delineating underlying obstructive hemodynamics and diagnosing specific occlusive disease entities. ©RSNA, 2022.
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Affiliation(s)
- Kenneth S Zurcher
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ (K.S.Z., S.O.S., S.J.A., I.J.P., S.G.N., R.O., M.G.K.); Minimally Invasive Procedure Specialists, Highlands Ranch, Colo (E.B.S., A.L.); and University of Illinois College of Medicine at Chicago, Chicago, IL (R.A.D.)
| | - Sasha O Staack
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ (K.S.Z., S.O.S., S.J.A., I.J.P., S.G.N., R.O., M.G.K.); Minimally Invasive Procedure Specialists, Highlands Ranch, Colo (E.B.S., A.L.); and University of Illinois College of Medicine at Chicago, Chicago, IL (R.A.D.)
| | - E Brooke Spencer
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ (K.S.Z., S.O.S., S.J.A., I.J.P., S.G.N., R.O., M.G.K.); Minimally Invasive Procedure Specialists, Highlands Ranch, Colo (E.B.S., A.L.); and University of Illinois College of Medicine at Chicago, Chicago, IL (R.A.D.)
| | - Addison Liska
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ (K.S.Z., S.O.S., S.J.A., I.J.P., S.G.N., R.O., M.G.K.); Minimally Invasive Procedure Specialists, Highlands Ranch, Colo (E.B.S., A.L.); and University of Illinois College of Medicine at Chicago, Chicago, IL (R.A.D.)
| | - Sadeer J Alzubaidi
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ (K.S.Z., S.O.S., S.J.A., I.J.P., S.G.N., R.O., M.G.K.); Minimally Invasive Procedure Specialists, Highlands Ranch, Colo (E.B.S., A.L.); and University of Illinois College of Medicine at Chicago, Chicago, IL (R.A.D.)
| | - Indravadan J Patel
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ (K.S.Z., S.O.S., S.J.A., I.J.P., S.G.N., R.O., M.G.K.); Minimally Invasive Procedure Specialists, Highlands Ranch, Colo (E.B.S., A.L.); and University of Illinois College of Medicine at Chicago, Chicago, IL (R.A.D.)
| | - Sailendra G Naidu
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ (K.S.Z., S.O.S., S.J.A., I.J.P., S.G.N., R.O., M.G.K.); Minimally Invasive Procedure Specialists, Highlands Ranch, Colo (E.B.S., A.L.); and University of Illinois College of Medicine at Chicago, Chicago, IL (R.A.D.)
| | - Rahmi Oklu
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ (K.S.Z., S.O.S., S.J.A., I.J.P., S.G.N., R.O., M.G.K.); Minimally Invasive Procedure Specialists, Highlands Ranch, Colo (E.B.S., A.L.); and University of Illinois College of Medicine at Chicago, Chicago, IL (R.A.D.)
| | - Ryanne A Dymek
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ (K.S.Z., S.O.S., S.J.A., I.J.P., S.G.N., R.O., M.G.K.); Minimally Invasive Procedure Specialists, Highlands Ranch, Colo (E.B.S., A.L.); and University of Illinois College of Medicine at Chicago, Chicago, IL (R.A.D.)
| | - Martha-Gracia Knuttinen
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ (K.S.Z., S.O.S., S.J.A., I.J.P., S.G.N., R.O., M.G.K.); Minimally Invasive Procedure Specialists, Highlands Ranch, Colo (E.B.S., A.L.); and University of Illinois College of Medicine at Chicago, Chicago, IL (R.A.D.)
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24
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Sheikh AB, Fudim M, Garg I, Minhas AMK, Sobotka AA, Patel MR, Eng MH, Sobotka PA. The Clinical Problem of Pelvic Venous Disorders. Interv Cardiol Clin 2022; 11:307-324. [PMID: 35710285 DOI: 10.1016/j.iccl.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Pelvic venous disorders are inter-related pathologic conditions caused by reflux and obstruction in the pelvic veins. It can present a spectrum of clinical features based on the route of transmission of venous hypertension to either distal or caudal venous reservoirs. Imaging can help to visualize pelvic vascular and visceral structures to rule out other gynecologic, gastrointestinal, and urologic diseases. Endovascular treatment, owing to its low invasive nature and high success rate, has become the mainstay in the management of pelvic venous disorders. This article reviews the pathophysiology, clinical presentations, and diagnostic and therapeutic approaches to pelvic venous disorders.
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Affiliation(s)
- Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, 1021 Medical Arts Avenue NE, Albuquerque, NM 87102, USA
| | - Marat Fudim
- Division of Cardiology, Duke University Medical Center, 200 Trent Drive, Durham, NC 27710, USA; Duke Clinical Research Institute, 300 West Morgan Street, Durham, NC 27701, USA.
| | - Ishan Garg
- Department of Internal Medicine, University of New Mexico Health Sciences Center, 1021 Medical Arts Avenue NE, Albuquerque, NM 87102, USA
| | - Abdul Mannan Khan Minhas
- Department of Internal Medicine, Forrest General Hospital, 6051 US 49, Hattiesburg, MS 39401, USA
| | | | - Manesh R Patel
- Division of Cardiology, Duke University Medical Center, 200 Trent Drive, Durham, NC 27710, USA; Duke Clinical Research Institute, 300 West Morgan Street, Durham, NC 27701, USA
| | - Marvin H Eng
- Division of Cardiology, University of Arizona, Banner University Medical Center, 1111 E McDowell Rd, Phoenix, AZ 85006, USA
| | - Paul A Sobotka
- The Ohio State University, 281 West Lane Avenue, Columbus, OH 43210, USA.
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Song YH, Xiang HY, Si KK, Wang ZH, Zhang Y, Liu C, Xu KS, Li X. Difference between type 2 gastroesophageal varices and isolated fundic varices in clinical profiles and portosystemic collaterals. World J Clin Cases 2022; 10:5620-5633. [PMID: 35979133 PMCID: PMC9258365 DOI: 10.12998/wjcc.v10.i17.5620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/17/2022] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is significant heterogeneity between gastroesophageal varices (GOV2) and isolated gastric varices (IGV1). The data on the difference between GOV2 and IGV1 are limited. AIM To determine the etiology, clinical profiles, endoscopic findings, imaging signs, portosystemic collaterals in patients with GOV2 and IGV1. METHODS Medical records of 252 patients with gastric fundal varices were retrospectively collected, and computed tomography images were analyzed. RESULTS Significant differences in routine blood examination, Child-Pugh classification and MELD scores were found between GOV2 and IGV1. The incidence of peptic ulcers in patients with IGV1 (26.55%) was higher than that of GOV2 (11.01%), while portal hypertensive gastropathy was more commonly found in patients with GOV2 (22.02%) than in those with IGV1 (3.54%). Typical radiological signs of cirrhotic liver were more commonly observed in patients with GOV2 than in those with IGV1. In patients with GOV2, the main afferent vessels were via the left gastric vein (LGV) (97.94%) and short gastric vein (SGV) (39.18%). In patients with IGV1, the main afferent vessels were via the LGV (75.61%), SGV (63.41%) and posterior gastric vein (PGV) (43.90%). In IGV1 patients with pancreatic diseases, spleno-gastromental-superior mesenteric shunt (48.15%) was a major collateral vessel. In patients with fundic varices, the sizes of gastric/esophageal varices were positively correlated with afferent vessels (LGVs and PGVs) and efferent vessels (gastrorenal shunts). The size of the esophageal varices was negatively correlated with gastrorenal shunts in GOV2 patients. CONCLUSION Significant heterogeneity in the etiology and vascular changes between GOV2 and IGV1 is useful in making therapeutic decisions.
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Affiliation(s)
- Yu-Hu Song
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Hong-Yu Xiang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Ke-Ke Si
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
- Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Ze-Hui Wang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Yu Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
- Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Chang Liu
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Ke-Shu Xu
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Xin Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
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Yi F, Guo X, Zeng QL, Yang B, He Y, Yuan S, Arora A, Qi X. Computed Tomography Images of Spontaneous Portosystemic Shunt in Liver Cirrhosis. Can J Gastroenterol Hepatol 2022; 2022:3231144. [PMID: 35719322 PMCID: PMC9200601 DOI: 10.1155/2022/3231144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/23/2022] [Accepted: 05/11/2022] [Indexed: 12/05/2022] Open
Abstract
Spontaneous portosystemic shunt (SPSS) refers to collateral vessels that communicate between the portal vein system and systemic circulation. SPSS mainly includes esophageal varices, gastric varices, left gastric vein, recanalized paraumbilical vein, abdominal wall varices, and spontaneous splenorenal shunt. SPSS contributes to the development of hepatic encephalopathy caused by portal vein inflow bypassing and carries a higher risk of death in liver cirrhosis. Abdominal contrast-enhanced computed tomography is a major imaging approach to establish a diagnosis of SPSS and evaluate its location and feature. This review primarily describes the main contrast-enhanced CT features of SPSS in liver cirrhosis.
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Affiliation(s)
- Fangfang Yi
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), Shenyang 110840, China
- Department of Infectious Diseases, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory for Accurate Diagnosis and Treatment of Chronic Liver Diseases, Wenzhou 325006, China
| | - Xiaozhong Guo
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), Shenyang 110840, China
| | - Qing-Lei Zeng
- Department of Infectious Diseases and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Benqiang Yang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang 110840, China
| | - Yanglan He
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), Shenyang 110840, China
- Postgraduate College, China Medical University, Shenyang 110122, China
| | - Shanshan Yuan
- Department of Gastroenterology, Xi'an Central Hospital, Xi'an 710003, China
| | - Ankur Arora
- Department of Radiology, Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Xingshun Qi
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), Shenyang 110840, China
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Hori A, Watanabe Y, Takahashi K, Tonouchi T, Kimura N, Setsu T, Ikarashi S, Kamimura H, Yokoyama J, Terai S. A rare case of duodenal variceal bleeding due to extrahepatic portal vein obstruction successfully treated with endoscopic injection sclerotherapy. Clin J Gastroenterol 2022; 15:617-622. [PMID: 35378714 DOI: 10.1007/s12328-022-01627-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
Primary extra-hepatic portal vein obstruction (EHPVO) is a disease that develops ectopic varices due to portal hypertension and obstruction of the portal vein. Since bleeding from ectopic varices is life-threatening, the management of ectopic varices is important for patients with primary EHPVO. Here, we report a case of duodenal variceal bleeding in a patient with primary EHPVO. A 39-year-old man was diagnosed with F2-shaped duodenal varices (DV) due to primary EHPVO and was first treated with endoscopic variceal ligation for temporary hemostasis. We then performed angiography to understand the detailed hemodynamics and subsequently conducted endoscopic injection sclerotherapy (EIS) with a sclerosing agent containing N-butyl-2-cyanoacrylate for further hemostasis. After the treatment, dynamic computed tomography and endoscopic ultrasound revealed that the blood flow to the causative DV disappeared, although the DV itself remained. The patient was discharged without any re-bleeding or adverse events. Since treatment for DV due to primary EHPVO differs depending on hemodynamics (hepatofugal or hepatopetal blood flow), evaluating detailed hemodynamics for optimal treatment selection is crucial. Although EIS for this patient was not a radical treatment, it was effective in managing acute bleeding from the DV. This case will serve as a reference for successful treatment in future cases.
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Affiliation(s)
- Ashu Hori
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Yusuke Watanabe
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
- Division of Preemptive Medicine for Digestive Disease and Healthy Active Life, School of Medicine, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan.
| | - Kazuya Takahashi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
- Division of Network Medicine for Digestive Diseases, School of Medicine, Niigata University, Niigata, Japan
| | - Takahumi Tonouchi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Naruhiro Kimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Toru Setsu
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Satoshi Ikarashi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Hiroteru Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
- Division of Network Medicine for Digestive Diseases, School of Medicine, Niigata University, Niigata, Japan
| | - Junji Yokoyama
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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Lesmana CRA, Nababan SH, Kalista KF, Kurniawan J, Jasirwan COM, Sulaiman AS, Hasan I, Gani RA. Impact of endoscopic ultrasound examination for deep esophageal collateral veins evaluation in liver cirrhosis patients prior to endoscopic treatment: A case series. PORTAL HYPERTENSION & CIRRHOSIS 2022; 1:76-81. [DOI: 10.1002/poh2.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/16/2022] [Indexed: 01/04/2025]
Abstract
AbstractAimThe presence of esophageal collateral veins (ECV) has been reported to be associated with the recurrence of esophageal varices (EV) and bleeding in liver cirrhotic (LC) patients. This study aimed to see the potential clinical value of deep collateral veins assessment using endoscopic ultrasound (EUS) in liver cirrhotic patients with EV.MethodsDuring 6 months period, a prospective study is conducted, where we identified LC patients who were admitted for esophagogastroduodenoscopy (EGD) screening at the Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Jakarta. ECV was examined using EUS. Patients were excluded if they had (1) liver malignancy, (2) history of ligation or glue injection, or (3) portal or splenic vein thrombus. We collected demographic data, medical history, data pertaining to use of nonselective beta blocker (NSBB), and laboratory, imaging, and endoscopy results. EGD was performed using a gastroscope (EG29‐i10, 3.2 mm Pentax Medical) while EUS was performed using a linear array echoendoscope (EG‐3870UTK, 3.8 mm, Pentax Medical) before band ligation or glue injection.ResultsThere were 20 LC patients included in this study, where 15 (75%) of patients were classified with Child–Pugh (CP)‐A and five (25%) of patients with CP‐B. The most common aetiologies were hepatitis B in seven (35%) patients and hepatitis C in nine (45%) patients. The EV with peri‐ or para‐esophageal veins (PEEV or PAEV) were detected in 65% of patients. None of the LC patients with no EV showed the presence of ECV. PEEV or PAEV were detected in grades 1–3 EV.ConclusionEUS examination can give a better evaluation before managing gastroesophageal varices through deep ECV detection in LC patients.
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Affiliation(s)
- Cosmas Rinaldi A. Lesmana
- Department of Internal Medicine, Hepatobiliary Division Dr. Cipto Mangunkusumo National General Hospital Jakarta Indonesia
- Digestive Disease and GI Oncology Center, Medistra Hospital Jakarta Indonesia
| | - Saut H. Nababan
- Department of Internal Medicine, Hepatobiliary Division Dr. Cipto Mangunkusumo National General Hospital Jakarta Indonesia
| | - Kemal F. Kalista
- Department of Internal Medicine, Hepatobiliary Division Dr. Cipto Mangunkusumo National General Hospital Jakarta Indonesia
| | - Juferdy Kurniawan
- Department of Internal Medicine, Hepatobiliary Division Dr. Cipto Mangunkusumo National General Hospital Jakarta Indonesia
| | - Chyntia O. M. Jasirwan
- Department of Internal Medicine, Hepatobiliary Division Dr. Cipto Mangunkusumo National General Hospital Jakarta Indonesia
| | - Andri S. Sulaiman
- Department of Internal Medicine, Hepatobiliary Division Dr. Cipto Mangunkusumo National General Hospital Jakarta Indonesia
| | - Irsan Hasan
- Department of Internal Medicine, Hepatobiliary Division Dr. Cipto Mangunkusumo National General Hospital Jakarta Indonesia
| | - Rino A. Gani
- Department of Internal Medicine, Hepatobiliary Division Dr. Cipto Mangunkusumo National General Hospital Jakarta Indonesia
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Pandhi MB, Kord A, Niemeyer MM. Transjugular Liver Biopsy: A Case of a Phrenic Vein Mimic of the Right Hepatic Vein. Semin Intervent Radiol 2022; 39:103-106. [PMID: 35210739 PMCID: PMC8856775 DOI: 10.1055/s-0041-1741079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mithil B. Pandhi
- Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois,Address for correspondence Mithil B. Pandhi, DO Department of Radiology, University of Illinois Hospital and Health Sciences System1740 W. Taylor St., M/C 931, Chicago, IL 60612
| | - Ali Kord
- Division of Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Matthew M. Niemeyer
- Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
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30
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Cognitive Impairement in Non-Cirrhotic Portal Hypertension: Highlights on Physiopathology, Diagnosis and Management. J Clin Med 2021; 11:jcm11010101. [PMID: 35011842 PMCID: PMC8745274 DOI: 10.3390/jcm11010101] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 11/18/2022] Open
Abstract
Hepatic encephalopathy (HE) is one of the most frequent complications of cirrhosis. Several studies and case reports have shown that cognitive impairment may also be a tangible complication of portal hypertension secondary to chronic portal vein thrombosis and to porto-sinusoidal vascular disease (PSVD). In these conditions, representing the main causes of non-cirrhotic portal hypertension (NCPH) in the Western world, both overt and minimal/covert HE occurs in a non-neglectable proportion of patients, even lower than in cirrhosis, and it is mainly sustained by the presence of large porto-systemic shunt. In these patients, the liver function is usually preserved or only mildly altered, and the development of porto-systemic shunt is either spontaneous or iatrogenically frequent; HE is an example of type-B HE. To date, in the absence of strong evidence and large cooperative studies, for the diagnosis and the management of HE in NCPH, the same approach used for HE occurring in cirrhosis is applied. The aim of this paper is to provide an overview of type B hepatic encephalopathy, focusing on its pathophysiology, diagnostic tools and management in patients affected by porto-sinusoidal vascular disease and chronic portal vein thrombosis.
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31
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Steggerda JA, Son AY, Pozo ME, Pawale A, Reynolds AS, Desai K, Galvez-Lima D, Herborn J, DeWolf A, Ladner D, Caicedo JC, Katariya N, Borja-Cacho D. Re-appropriation of a right anterior thoracotomy approach to portal-systemic bypass for liver transplantation in a patient with complete superior vena cava occlusion. TRANSPLANTATION REPORTS 2021. [DOI: 10.1016/j.tpr.2021.100086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ono Y, Inoue Y, Kato T, Matsueda K, Oba A, Sato T, Ito H, Saiura A, Takahashi Y. Sinistral Portal Hypertension after Pancreaticoduodenectomy with Splenic Vein Resection: Pathogenesis and Its Prevention. Cancers (Basel) 2021; 13:cancers13215334. [PMID: 34771498 PMCID: PMC8582504 DOI: 10.3390/cancers13215334] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022] Open
Abstract
To achieve curative resection for pancreatic cancer during pancreaticoduodenectomy (PD), extensive portal vein (PV) resection, including porto-mesenterico-splenic confluence (PMSC), may sometimes be necessary if the tumor is close to the portal venous system. Recently, this extended resection has been widely accepted in high-volume centers for pancreatic resection due to its favorable outcomes compared with non-operative treatment. However, in patients with long-term survival, sinistral portal hypertension (SPH) occurs as a late-onset postoperative complication. These patients present gastrointestinal varices due to congested venous flow from the spleen, which may cause critical variceal bleeding. Since the prognosis of patients with pancreatic cancer has improved, owing to the development of chemotherapy and surgical techniques, SPH is no longer a negligible matter in the field of pancreatic cancer surgery. This review clarifies the pathogenesis and frequency of SPH after PD through PMSC resection and discusses its prediction and prevention.
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Affiliation(s)
- Yoshihiro Ono
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (Y.O.); (T.K.); (A.O.); (T.S.); (H.I.); (Y.T.)
| | - Yosuke Inoue
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (Y.O.); (T.K.); (A.O.); (T.S.); (H.I.); (Y.T.)
- Correspondence: ; Tel.: +81-3-3520-0111
| | - Tomotaka Kato
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (Y.O.); (T.K.); (A.O.); (T.S.); (H.I.); (Y.T.)
| | - Kiyoshi Matsueda
- Department of Diagnostic Imaging, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan;
| | - Atsushi Oba
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (Y.O.); (T.K.); (A.O.); (T.S.); (H.I.); (Y.T.)
| | - Takafumi Sato
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (Y.O.); (T.K.); (A.O.); (T.S.); (H.I.); (Y.T.)
| | - Hiromichi Ito
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (Y.O.); (T.K.); (A.O.); (T.S.); (H.I.); (Y.T.)
| | - Akio Saiura
- Department of Hepatobiliary-Pancreatic Surgery, School of Medicine, Juntendo University, Tokyo 113-0033, Japan;
| | - Yu Takahashi
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (Y.O.); (T.K.); (A.O.); (T.S.); (H.I.); (Y.T.)
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Isoura Y, Yamamoto A, Cho Y, Ehara E, Jogo A, Suzuki T, Amano-Teranishi Y, Kioka K, Hamazaki T, Murakami Y, Tokuhara D. Platelet count and abdominal dynamic CT are useful in predicting and screening for gastroesophageal varices after Fontan surgery. PLoS One 2021; 16:e0257441. [PMID: 34618830 PMCID: PMC8496823 DOI: 10.1371/journal.pone.0257441] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/02/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Patients who undergo Fontan surgery for complex cardiac anomalies are prone to developing liver and gastrointestinal complications. In particular, gastroesophageal varices (GEVs) can occur, but their prevalence is unknown. We aimed to elucidate the occurrence of GEVs and the predicting parameters of GEVs in these patients. MATERIALS AND METHODS Twenty-seven patients (median age, 14.8 years; median time since surgery, 12.9 years) who had undergone the Fontan surgery and were examined by abdominal dynamic computed tomography (CT) for the routine follow-up were included in the study. Radiological findings including GEVs and extraintestinal complications were retrospectively evaluated by experienced radiologists in a blinded manner. Relationships between blood-biochemical and demographic parameters and the presence of GEVs were statistically analyzed. RESULTS Dynamic CT revealed gastric varices (n = 3, 11.1%), esophageal varices (n = 1, 3.7%), and gastrorenal shunts (n = 5, 18.5%). All patients with gastric varices had gastrorenal shunts. All gastric varices were endoscopically confirmed as being isolated and enlarged, with indications for preventive interventional therapy. A platelet count lower than 119 × 109 /L was identified as a predictor of GEV (area under the receiver operating curve, 0.946; sensitivity, 100%; and specificity, 87%). CONCLUSIONS GEVs are important complications that should not be ignored in patients who have undergone a Fontan procedure. Platelet counts lower than 119 × 109 /L may help to prompt patient screening by using abdominal dynamic CT to identify GEVs and their draining collateral veins in these patients.
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Affiliation(s)
- Yoshiharu Isoura
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akira Yamamoto
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yuki Cho
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Eiji Ehara
- Department of Pediatric Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Atsushi Jogo
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tsugutoshi Suzuki
- Department of Pediatric Electrophysiology, Osaka City General Hospital, Osaka, Japan
| | | | - Kiyohide Kioka
- Department of Hepatology, Osaka City General Hospital, Osaka, Japan
| | - Takashi Hamazaki
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yosuke Murakami
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan
- Department of Pediatric Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Daisuke Tokuhara
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan
- * E-mail:
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Bhattacharya D, Sasikumar D, Gopalakrishnan A, Anoop A. Ventricular septal defect with pulmonary arterial hypertension in an infant: Is there something more than what meets the eye? Ann Pediatr Cardiol 2021; 14:554-556. [PMID: 35527760 PMCID: PMC9075548 DOI: 10.4103/apc.apc_226_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/26/2021] [Accepted: 05/10/2021] [Indexed: 12/02/2022] Open
Abstract
An 11-month-old girl was detected to have muscular ventricular septal defect with hyperkinetic pulmonary hypertension (PH) was urgently operated upon. On follow-up, her PH worsened, resulting in right ventricular dysfunction and was later detected to have absent portal vein.
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Affiliation(s)
- Deepanjan Bhattacharya
- Department of Cardiology, Sree Chitra Tirunal Insitute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Deepa Sasikumar
- Department of Cardiology, Sree Chitra Tirunal Insitute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Arun Gopalakrishnan
- Department of Cardiology, Sree Chitra Tirunal Insitute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - A Anoop
- Department of Imaging Sciences and Intervention Radiology, Sree Chitra Tirunal Insitute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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An Uncommon Cause of Biliary Obstruction in a Patient With Budd-Chiari Syndrome. ACG Case Rep J 2021; 8:e00597. [PMID: 34549066 PMCID: PMC8443805 DOI: 10.14309/crj.0000000000000597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 02/16/2021] [Indexed: 11/17/2022] Open
Abstract
Biliary varices (BVs) are an infrequent complication of chronic portal hypertension. Most cases of BVs are asymptomatic and are likely underdiagnosed. We present a case of a 34-year-old woman with Budd-Chiari syndrome who was found to have BVs caused by a significant inferior vena cava (IVC) stenosis. This case demonstrates that preprocedure imaging for variceal screening should be considered before biliary tract procedures to prevent complications.
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Brahmbhatt A, Macher J, Shetty AN, Chughtai K, Baah NO, Dogra VS. Sonographic Evaluation of Pelvic Venous Disorders. Ultrasound Q 2021; 37:219-228. [PMID: 34478419 DOI: 10.1097/ruq.0000000000000576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Pelvic venous disorders are a group of interrelated conditions characterized by venous incompetence. These conditions often manifest with nonspecific symptoms that overlap with many gynecological, gastrointestinal, and urologic diseases. Clinical diagnosis can be difficult, and imaging can play a vital role in differentiating etiology. Sonographic evaluation is often the first step in evaluating these symptoms. Special attention to possible underlying pelvic venous disorders can reveal characteristic findings, support diagnosis, and guide treatment. Here we review pelvic congestion syndrome, nutcracker syndrome, May-Thurner syndrome, and other venous disorders, with a specific focus on sonographic findings and considerations.
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Kim J, Randhawa H, Sands D, Lambe S, Puglia M, Serrano PE, Pinthus JH. Muscle-Invasive Bladder Cancer in Patients with Liver Cirrhosis: A Review of Pertinent Considerations. Bladder Cancer 2021; 7:261-278. [PMID: 38993608 PMCID: PMC11181825 DOI: 10.3233/blc-211536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/09/2021] [Indexed: 11/15/2022]
Abstract
The incidence of liver cirrhosis is increasing worldwide. Patients with cirrhosis are generally at a higher risk of harbouring hepatic and non-hepatic malignancies, including bladder cancer, likely due to the presence of related risk factors such as smoking. Cirrhosis can complicate both the operative and non-surgical management of bladder cancer. For example, cirrhotic patients undergoing abdominal surgery generally demonstrate worse postoperative outcomes, and chemotherapy in patients with cirrhosis often requires dose reduction due to its direct hepatotoxic effects and reduced hepatic clearance. Multiple other considerations in the peri-operative management for cirrhosis patients with muscle-invasive bladder cancer must be taken into account to optimize outcomes in these patients. Unfortunately, the current literature specifically related to the treatment of cirrhotic bladder cancer patients remains sparse. We aim to review the literature on treatment considerations for this patient population with respect to perioperative, surgical, and adjuvant management.
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Affiliation(s)
- John Kim
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - David Sands
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Shahid Lambe
- Division of Urology, McMaster University, Hamilton, ON, Canada
- McMaster Institute of Urology, St. Joseph’s Hospital, Hamilton, ON, Canada
| | - Marco Puglia
- Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada
| | | | - Jehonathan H. Pinthus
- Division of Urology, McMaster University, Hamilton, ON, Canada
- Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada
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Rajesh S, Philips CA, Ahamed R, Abduljaleel JK, Nair DC, Augustine P. Friend or Foe? Spontaneous Portosystemic Shunts in Cirrhosis-Current Understanding and Future Prospects. Can J Gastroenterol Hepatol 2021; 2021:8795115. [PMID: 34422711 PMCID: PMC8376437 DOI: 10.1155/2021/8795115] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/02/2021] [Indexed: 02/07/2023] Open
Abstract
Portal hypertension (PHT) in cirrhosis results from increased resistance to splanchnic blood flow secondary to parenchymal and vascular changes within the liver. In an attempt to counteract the increased portal pressure, two mechanisms simultaneously occur: splanchnic vasodilatation and formation of spontaneous portosystemic shunts (SPSS). Long considered to be a compensatory mechanism to decompress the portal venous system, it is now well established that SPSS are not only inefficient in decreasing the portal pressure but also contribute to reduced hepatocyte perfusion and increased splanchnic blood flow and resistance, associated with worsening PHT. Recent studies have described a high prevalence of SPSS in cirrhosis patients, increasing with liver dysfunction, and observed an association between the presence of SPSS and worse clinical outcomes. In cirrhosis patients with preserved liver functions, the presence of SPSS independently increases the risk of hepatic encephalopathy, variceal bleeding, and ascites, and reduces transplant-free survival. Moreover, the presence of SPSS in patients undergoing transjugular intrahepatic portosystemic shunting and liver transplant has been shown to variably affect the postprocedural outcome. This article provides an overview of the current understanding of the role of SPSS in the natural history of liver cirrhosis and their status as a therapeutic target and an imaging biomarker to identify patients at higher risk of developing complications of PHT.
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Affiliation(s)
- Sasidharan Rajesh
- Department of GI and HPB Interventional Radiology, The Liver Institute, Center of Excellence in GI Sciences, Rajagiri Hospital, Aluva, Kerala, India
| | - Cyriac Abby Philips
- Department of Clinical and Translational Hepatology, The Liver Institute, Center of Excellence in GI Sciences, Rajagiri Hospital, Aluva, Kerala, India
| | - Rizwan Ahamed
- Department Gastroenterology and Advanced GI Endoscopy, Center of Excellence in GI Sciences, Rajagiri Hospital, Aluva, Kerala, India
| | - Jinsha K Abduljaleel
- Department Gastroenterology and Advanced GI Endoscopy, Center of Excellence in GI Sciences, Rajagiri Hospital, Aluva, Kerala, India
| | - Dinu Chandran Nair
- Department of GI and HPB Interventional Radiology, The Liver Institute, Center of Excellence in GI Sciences, Rajagiri Hospital, Aluva, Kerala, India
| | - Philip Augustine
- Department Gastroenterology and Advanced GI Endoscopy, Center of Excellence in GI Sciences, Rajagiri Hospital, Aluva, Kerala, India
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Zhou LL, Wang GC, Zhang MY, Huang GJ, Li W, Wang LY, Wang AH, Zhang CQ. Nomogram for hepatic venous pressure gradient in patients with cirrhosis. J Dig Dis 2021; 22:488-495. [PMID: 34272920 DOI: 10.1111/1751-2980.13033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 07/02/2021] [Accepted: 07/14/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The hepatic venous pressure gradient (HVPG) plays an important role in the treatment and prognosis of patients with cirrhosis. Our study aimed to develop and validate a nomogram for an HVPG >12 mmHg. METHODS A retrospective study was performed to create a nomogram for an HVPG >12 mmHg in a training cohort that was validated in another cohort. The discriminatory ability and calibration of the nomogram were tested using the C-statistic, area under the receiver operating characteristic curve (AUROC) and calibration plots. RESULTS The nomogram was based on portosystemic shunts identified on computed tomography images, the etiology of cirrhosis and the Child-Pugh grade. These parameters were significantly associated with an HVPG >12 mmHg (P < 0.05 for both the training and validation cohorts). In the training cohort, the model showed good discrimination (C-statistic, AUROC, and R2 of 0.71, 0.71 and 0.13, respectively) and good calibration. The total cutoff value was 112 and the sensitivity and specificity were 57.1% and 77.6%, respectively. The application of the nomogram in the validation cohort still yielded good discrimination (C-statistic 0.75 [95% confidence interval 0.61-0.89], AUROC 0.75, and R2 0.16) and good calibration. CONCLUSIONS This nomogram is a convenient tool for predicting an HVPG >12 mmHg in patients with cirrhosis and can help clinicians quickly identify patients with decompensated cirrhosis.
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Affiliation(s)
- Li Li Zhou
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China.,Department of Gastroenterology, Jining No. 1 People's Hospital, Jining, Shandong Province, China
| | - Guang Chuan Wang
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
| | - Ming Yan Zhang
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
| | - Guang Jun Huang
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
| | - Wen Li
- Digestive Diseases Hospital of Shandong First Medical Uniersity, Jining, Shandong Province, China
| | - Ling Yun Wang
- Department of Gastroenterology, Jining No. 1 People's Hospital, Jining, Shandong Province, China
| | - Ai Hua Wang
- Department of Gastroenterology, Linyi People's Hospital, Linyi, Shandong Province, China
| | - Chun Qing Zhang
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
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Barath S, Kheradia D, Gopalkrishnan SP, R. RK, K. MRP. Review of Applied Anatomy, Hemodynamics, and Endovascular Management of Ectopic Varices. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1730868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractPortal hypertension leads to the opening up of collateral pathways to bypass the occlusion or resistance in the portal system. Ectopic varices are formed by such collaterals at many various sites along the gastrointestinal tract other than the usual location, that is, gastroesophageal region. Early diagnosis of ectopic varices needs strong clinical suspicion and contrast-enhanced computed tomography scan as endoscopy may often fail to pinpoint a source. In contrast to gastric varices where the understanding of the disease, as well as endovascular management, is widely studied and documented, the same is not true for ectopic varices due to low incidence. Understanding the applied anatomy and hemodynamic classification is important to decide the most suitable therapy. Interventional radiological procedures are aimed at either decompressing the varices or obliterating them and depend on the patency of the portal system, underlying etiology, and local expertise.
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Affiliation(s)
- Sitaram Barath
- Interventional Radiology Subdivision, Department of Radiology, Geetanjali Medical College & Hospital, Udaipur, Rajasthan, India
| | | | | | - Rahul K. R.
- Government Medical College, Kozhikode, Kerala, India
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Spaide RF, Gemmy Cheung CM, Matsumoto H, Kishi S, Boon CJF, van Dijk EHC, Mauget-Faysse M, Behar-Cohen F, Hartnett ME, Sivaprasad S, Iida T, Brown DM, Chhablani J, Maloca PM. Venous overload choroidopathy: A hypothetical framework for central serous chorioretinopathy and allied disorders. Prog Retin Eye Res 2021; 86:100973. [PMID: 34029721 DOI: 10.1016/j.preteyeres.2021.100973] [Citation(s) in RCA: 185] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 12/19/2022]
Abstract
In central serous chorioretinopathy (CSC), the macula is detached because of fluid leakage at the level of the retinal pigment epithelium. The fluid appears to originate from choroidal vascular hyperpermeability, but the etiology for the fluid is controversial. The choroidal vascular findings as elucidated by recent optical coherence tomography (OCT) and wide-field indocyanine green (ICG) angiographic evaluation show eyes with CSC have many of the same venous patterns that are found in eyes following occlusion of the vortex veins or carotid cavernous sinus fistulas (CCSF). The eyes show delayed choroidal filling, dilated veins, intervortex venous anastomoses, and choroidal vascular hyperpermeability. While patients with occlusion of the vortex veins or CCSF have extraocular abnormalities accounting for the venous outflow problems, eyes with CSC appear to have venous outflow abnormalities as an intrinsic phenomenon. Control of venous outflow from the eye involves a Starling resistor effect, which appears to be abnormal in CSC. Similar choroidal vascular abnormalities have been found in peripapillary pachychoroid syndrome. However, peripapillary pachychoroid syndrome has intervortex venous anastomoses located in the peripapillary region while in CSC these are seen to be located in the macular region. Spaceflight associated neuro-ocular syndrome appears to share many of the pathophysiologic problems of abnormal venous outflow from the choroid along with a host of associated abnormalities. These diseases vary according to their underlying etiologies but are linked by the venous decompensation in the choroid that leads to significant vision loss. Choroidal venous overload provides a unifying concept and theory for an improved understanding of the pathophysiology and classification of a group of diseases to a greater extent than previous proposals.
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Affiliation(s)
- Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, NY, USA.
| | | | - Hidetaka Matsumoto
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Japan.
| | | | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands.
| | | | | | | | | | | | | | - Jay Chhablani
- University of Pittsburgh, UPMC Eye Center, Pittsburgh, PA, USA.
| | - Peter M Maloca
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland.
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Mallea P, Allen A, Lynch MK, Jensen-Otsu E, Tompkins D. Massive gastrointestinal bleeding due to ectopic varix in distal duodenum: a case report. J Community Hosp Intern Med Perspect 2021; 11:370-375. [PMID: 34234909 PMCID: PMC8118526 DOI: 10.1080/20009666.2021.1890338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Duodenal ectopic varices (DEV) are an uncommon etiology of upper gastrointestinal bleeding and are associated with high mortality. Both the diagnosis and management of DEV are challenging. Multiple treatment modalities exist including endoscopic guided management (ligation and sclerotherapy), surgical resection, transvenous obliteration and transjugular intrahepatic portosystemic shunt (TIPS), but management depends on the underlying vascular anatomy and underlying pathology. We present a case of a 41-year-old man with a history of an alcohol use disorder, prior splenic vein thrombosis as a complication of pancreatitis who presented with massive gastrointestinal bleeding, and was ultimately diagnosed with distal duodenal ectopic varix, which contained inflow from a medial branch of the superior mesenteric vein and outflow into the left renal vein. He was successfully treated with transjugular portosystemic shunt and coil embolization.
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Affiliation(s)
- Patrick Mallea
- University of Utah School of Medicine, Salt Lake City, USA
| | - Aaron Allen
- Department of Diagnostic Radiology, Boise Veterans Administration Medical Center, Boise, USA
| | - Maureen Kim Lynch
- Department of General Surgery, Boise Veterans Administration Medical Center, Boise, USA
| | - Elsbeth Jensen-Otsu
- Department of Internal Medicine, Section of Gastroenterology, Boise Veterans Administration Medical Center, Boise, USA
| | - David Tompkins
- Department of Internal Medicine, Boise Veterans Administration Medical Center, Boise, USA
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Campione A, Agresta G, Locatelli D, Pozzi F. Cauda equina syndrome secondary to portal vein thrombosis: case report of favorable outcome with conservative treatment. J Neurosurg Spine 2021. [DOI: 10.3171/2020.7.spine20625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Epidural varicosis is a rare though well-known cause of cauda equina syndrome (CES). Although inferior vena cava (IVC) obstruction is the most common finding in such cases, portal vein hypertension can lead to epidural venous plexus engorgement by means of lumbar portocaval shunt activation.
A 40-year-old woman presented with right-sided sciatica, which progressed to right foot drop and a 3-day history of vesical tenesmus and fecal retention. She was initially diagnosed with L4–5 lumbar disc protrusion. However, contrast-enhanced lumbar MRI scan showed the presence of epidural varices in the L3–S1 tract. Given the absence of vascular anomalies amenable to resection, etiological conservative treatment was addressed. Therefore, a complete diagnostic workup was performed and revealed deep vein thrombosis (DVT), pulmonary embolism, and portal vein thrombosis. Oral anticoagulant therapy was initiated and prompt resolution of CES was observed. To the authors’ knowledge, this is the first report of CES secondary to epidural varicosis in the setting of acute portal vein thrombosis and extrahepatic portal vein obstruction (EHPVO). In cases of epidural varicosis, conservative etiological treatment is the most appropriate choice as CES may be the epiphenomenon of underlying systemic pathophysiological processes.
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Affiliation(s)
- Alberto Campione
- Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi—ASST Settelaghi; and
- Department of Neurosurgery, Università degli Studi dell’Insubria, and
| | - Gianluca Agresta
- Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi—ASST Settelaghi; and
| | - Davide Locatelli
- Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi—ASST Settelaghi; and
- Department of Neurosurgery, Università degli Studi dell’Insubria, and
- Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, Università degli Studi dell’Insubria, Varese, Italy
| | - Fabio Pozzi
- Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi—ASST Settelaghi; and
- Department of Neurosurgery, Università degli Studi dell’Insubria, and
- Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, Università degli Studi dell’Insubria, Varese, Italy
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Abstract
Cirrhosis is the fifth leading cause of death in adults. Advanced cirrhosis can cause significant portal hypertension (PH), which is responsible for many of the complications observed in patients with cirrhosis, such as varices. If portal pressure exceeds a certain threshold, the patient is at risk of developing life-threatening bleeding from varices. Variceal bleeding has a high incidence among patients with liver cirrhosis and carries a high risk of mortality and morbidity. The management of variceal bleeding is complex, often requiring a multidisciplinary approach involving pharmacological, endoscopic, and radiologic interventions. In terms of management, three stages can be considered: primary prophylaxis, active bleeding, and secondary prophylaxis. The main goal of primary and secondary prophylaxis is to prevent variceal bleeding. However, active variceal bleeding is a medical emergency that requires swift intervention to stop the bleeding and achieve durable hemostasis. We describe the pathophysiology of cirrhosis and PH to contextualize the formation of gastric and esophageal varices. We also discuss the currently available treatments and compare how they fare in each stage of clinical management, with a special focus on drugs that can prevent bleeding or assist in achieving hemostasis.
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45
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Wang X, Wu B. Endoscopic sequential therapy for portal hypertension: Concept and clinical efficacy. LIVER RESEARCH 2021; 5:7-10. [PMID: 39958924 PMCID: PMC11791813 DOI: 10.1016/j.livres.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/04/2020] [Accepted: 12/24/2020] [Indexed: 02/16/2023]
Affiliation(s)
- Xing Wang
- Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Province Engineering and Technology Research Center of Digestive Endoscopy, Guangzhou, China
| | - Bin Wu
- Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Province Engineering and Technology Research Center of Digestive Endoscopy, Guangzhou, China
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Campione A, Agresta G, Locatelli D, Pozzi F. Cauda equina syndrome secondary to portal vein thrombosis: case report of favorable outcome with conservative treatment. J Neurosurg Spine 2021:1-6. [PMID: 33386000 DOI: 10.3171/2020.6.spine20625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/31/2020] [Indexed: 11/06/2022]
Abstract
Epidural varicosis is a rare though well-known cause of cauda equina syndrome (CES). Although inferior vena cava (IVC) obstruction is the most common finding in such cases, portal vein hypertension can lead to epidural venous plexus engorgement by means of lumbar portocaval shunt activation.A 40-year-old woman presented with right-sided sciatica, which progressed to right foot drop and a 3-day history of vesical tenesmus and fecal retention. She was initially diagnosed with L4-5 lumbar disc protrusion. However, contrast-enhanced lumbar MRI scan showed the presence of epidural varices in the L3-S1 tract. Given the absence of vascular anomalies amenable to resection, etiological conservative treatment was addressed. Therefore, a complete diagnostic workup was performed and revealed deep vein thrombosis (DVT), pulmonary embolism, and portal vein thrombosis. Oral anticoagulant therapy was initiated and prompt resolution of CES was observed. To the authors' knowledge, this is the first report of CES secondary to epidural varicosis in the setting of acute portal vein thrombosis and extrahepatic portal vein obstruction (EHPVO). In cases of epidural varicosis, conservative etiological treatment is the most appropriate choice as CES may be the epiphenomenon of underlying systemic pathophysiological processes.
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Affiliation(s)
- Alberto Campione
- 1Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi-ASST Settelaghi; and
- 2Department of Neurosurgery, Università degli Studi dell'Insubria, and
| | - Gianluca Agresta
- 1Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi-ASST Settelaghi; and
| | - Davide Locatelli
- 1Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi-ASST Settelaghi; and
- 2Department of Neurosurgery, Università degli Studi dell'Insubria, and
- 3Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, Università degli Studi dell'Insubria, Varese, Italy
| | - Fabio Pozzi
- 1Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi-ASST Settelaghi; and
- 2Department of Neurosurgery, Università degli Studi dell'Insubria, and
- 3Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, Università degli Studi dell'Insubria, Varese, Italy
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Maeda H, Kageyama K, Yamamoto A, Jogo A, Sohgawa E, Matsushita K, Asano K, Yonezawa H, Nota T, Murai K, Ogawa S, Miki Y. Usefulness of coil-assisted retrograde transvenous obliteration II (CARTO-II) for the treatment of ascending colonic varix: a case report. CVIR Endovasc 2020; 3:90. [PMID: 33275189 PMCID: PMC7718362 DOI: 10.1186/s42155-020-00187-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/30/2020] [Indexed: 12/17/2022] Open
Abstract
Background Colonic varices are rare among ectopic varices. A previous report demonstrated that once bleeding from colonic varices occurs, it can be fatal. Several treatments for colonic varices exist, including surgical, endoscopic, and endovascular treatments; however, management of colonic varices has not been standardized. For colonic varices, minimally invasive therapies would be desirable. Balloon-occluded retrograde transvenous obliteration (B-RTO) is one of the treatment options for colonic varices to prevent their rupture. Two cases of successful conventional B-RTO for these varices have already been reported. However, B-RTO using coil-assisted retrograde transvenous obliteration II (CARTO-II) procedure for these varices has not been reported. Case presentation A 71-year-old male patient had liver cirrhosis caused by hepatitis C virus infection. A varix was located at the ascending colon, which was coincidentally found on colonic endoscopy. Contrast-enhanced computed tomography (CT) showed that the feeder vein was the ileocolic vein and that the main draining vein was the right renal vein. Physicians concluded that treatment was required to avoid the risk of death from massive bleeding due to varix rupture. However, endoscopic and surgical treatments were difficult due to the anatomical location of the varix and the high risk of operative compilations, respectively. This ascending colonic varix was treated by balloon-occluded retrograde transvenous obliteration (B-RTO) using coil-assisted retrograde transvenous obliteration II (CARTO-II) procedure via the right renal vein. There were no complications during the procedure and no recurrences for 36 months during long-term follow-up. Conclusions CARTO-II can be one of the effective treatment techniques for ascending colonic varices.
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Affiliation(s)
- Hiroyuki Maeda
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Ken Kageyama
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan.
| | - Akira Yamamoto
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Atsushi Jogo
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Etsuji Sohgawa
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Kazuki Matsushita
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Kazuo Asano
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Hiroki Yonezawa
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Takehito Nota
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Kazuki Murai
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Satoyuki Ogawa
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
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Nam NH, Taura K, Yao S, Kaido T, Uemoto Y, Kimura Y, Anazawa T, Fukumitsu K, Ito T, Yagi S, Kamo N, Hata K, Uemoto S. Pretransplantation splenomegaly frequently persists after liver transplantation and can manifest as hypersplenism and graft fibrosis - a retrospective study. Transpl Int 2020; 33:1807-1820. [PMID: 33166011 DOI: 10.1111/tri.13761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/21/2020] [Accepted: 09/28/2020] [Indexed: 12/23/2022]
Abstract
The risk factors and clinical impact of post-transplantation splenomegaly (SM) are poorly understood. We investigated the predictors and impacts of post-transplantation SM in 415 LT patients at Kyoto University Hospital from April 2006 to December 2015. First, the predictors and clinical consequences of SM three years post-transplantation were analyzed among spleen-preserved recipients. Second, the clinical data of surviving recipients three years post-transplantation were compared between splenectomized and spleen-preserved recipients. There was no difference in indication for liver transplantation between these two groups. Third, survival outcomes were compared between splenectomized and spleen-preserved recipients. SM was determined as a SV/body surface area (BSA) higher than 152 ml/m2 . In the first analysis, preoperative SM occurred in 79.9% recipients and SM persisted three years post-transplantation in 72.6% recipients among them. Preoperative SV/BSA was the only independent predictor of three year post-transplantation SM, which was associated with lower platelet (PLT), white blood cell (WBC) counts and significant graft fibrosis (21.4% vs. 2.8%). In the second analysis, spleen-preservation was related to lower PLT, WBC counts and a higher proportion of significant graft fibrosis (26.7% vs. 7.1%) three years post-transplantation. In the third analysis, spleen-preserved recipients showed worse survival than splenectomized recipients. In conclusion, preoperative SM frequently persists more than three years post-transplantation and is associated with subclinical hypersplenism, graft fibrosis, graft loss, and even death.
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Affiliation(s)
- Nguyen Hai Nam
- Division of Hepato Biliary Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kojiro Taura
- Division of Hepato Biliary Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Siyuan Yao
- Division of Hepato Biliary Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshimi Kaido
- Division of Hepato Biliary Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yusuke Uemoto
- Division of Hepato Biliary Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yusuke Kimura
- Division of Hepato Biliary Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayuki Anazawa
- Division of Hepato Biliary Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ken Fukumitsu
- Division of Hepato Biliary Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Ito
- Division of Hepato Biliary Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shintaro Yagi
- Division of Hepato Biliary Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoko Kamo
- Division of Hepato Biliary Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichiro Hata
- Division of Hepato Biliary Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Uemoto
- Division of Hepato Biliary Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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49
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Paley EL. Discovery of Gut Bacteria Specific to Alzheimer's Associated Diseases is a Clue to Understanding Disease Etiology: Meta-Analysis of Population-Based Data on Human Gut Metagenomics and Metabolomics. J Alzheimers Dis 2020; 72:319-355. [PMID: 31561379 DOI: 10.3233/jad-190873] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Alzheimer's disease (AD)-associated sequence (ADAS) of cultured fecal bacteria was discovered in human gut targeted screening. This study provides important information to expand our current understanding of the structure/activity relationship of ADAS and putative inhibitors/activators that are potentially involved in ADAS appearance/disappearance. The NCBI database analysis revealed that ADAS presents at a large proportion in American Indian Oklahoman (C&A) with a high prevalence of obesity/diabetes and in colorectal cancer (CRC) patients from the US and China. An Oklahoman non-native group (NNI) showed no ADAS. Comparison of two large US populations reveals that ADAS is more frequent in individuals aged ≥66 and in females. Prevalence and levels of fecal metabolites are altered in the C&A and CRC groups versus controls. Biogenic amines (histamine, tryptamine, tyramine, phenylethylamine, cadaverine, putrescine, agmatine, spermidine) that present in food and are produced by gut microbiota are significantly higher in C&A (e.g., histamine/histidine 95-fold) versus NNI (histamine/histidine 16-fold). The majority of these bio-amines are cytotoxic at concentrations found in food. Inositol phosphate signaling implicated in AD is altered in C&A and CRC. Tryptamine stimulated accumulation of inositol phosphate. The seizure-eliciting tryptamine induced cytoplasmic vacuolization and vesiculation with cell fragmentation. Present additions of ADAS-carriers at different ages including infants led to an ADAS-comprising human sample size of 2,830 from 27 studies from four continents (North America, Australia, Asia, Europe). Levels of food-derived monoamine oxidase inhibitors and anti-bacterial compounds, the potential modulators of ADAS-bacteria growth and biogenic amine production, were altered in C&A versus NNI. ADAS is attributable to potentially modifiable risk factors of AD associated diseases.
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Affiliation(s)
- Elena L Paley
- Expert Biomed, Inc., Miami, FL, USA.,Stop Alzheimers Corp, Miami, FL, USA
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50
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Azizova A, Onder O, Arslan S, Ardali S, Hazirolan T. Persistent left superior vena cava: clinical importance and differential diagnoses. Insights Imaging 2020; 11:110. [PMID: 33057803 PMCID: PMC7561662 DOI: 10.1186/s13244-020-00906-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/20/2020] [Indexed: 01/07/2023] Open
Abstract
Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly and may be a component of the complex cardiac pathologies. While it is often asymptomatic, it can lead to significant problems such as arrhythmias and cyanosis. Besides, it can cause serious complications during vascular interventional procedures or the surgical treatment of cardiac anomalies (CA). The clinical significance of PLSVC depends on the drainage site and the accompanying CA. In this article, we will describe the epidemiology, embryology, and anatomic variations of PLSVC. Possible accompanying CA and heterotaxy spectrum will be reviewed with the help of multidetector computed tomography (MDCT) images. Radiological pitfalls, differential diagnoses, and the clinical importance of PLSVC will be highlighted.
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Affiliation(s)
- Aynur Azizova
- grid.14442.370000 0001 2342 7339Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey
| | - Omer Onder
- grid.14442.370000 0001 2342 7339Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey
| | - Sevtap Arslan
- grid.14442.370000 0001 2342 7339Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey
| | - Selin Ardali
- grid.14442.370000 0001 2342 7339Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey
| | - Tuncay Hazirolan
- grid.14442.370000 0001 2342 7339Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey
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