Changes in liver function parameters after occlusion of gastrorenal shunts with balloon-occluded retrograde transvenous obliteration.
OBJECTIVE
To evaluate the effects of portal blood flow on liver function, this pilot study investigated the correlation between changes in portal blood flow as measured by image-directed Doppler ultrasonography and liver function tests in nine patients with cirrhosis who were treated with balloon-occluded retrograde transvenous obliteration. All patients had large gastric varices and prominent gastrorenal shunts.


RESULTS
Treatment caused a significant increase (p < 0.01) in portal blood flow; we documented reversion from hepatofugal to hepatopetal portal flow in one patient and increases in hepatopetal flow from 5.4 +/- 1.1 to 7.85 +/- 1.4 cm/s (mean +/- SD) in eight patients. All patients showed decreases in gastric variceal size. However, portal pressure rose significantly in all patients after treatment from 25.4 +/- 7.6 to 30.7 +/- 5.8 mmH2O (n = 7, mean +/- SD), and two of nine patients had worsening of esophageal varices. All nine patients showed improvement in the 15-min retention rate of indocyanine green from 31.8 +/- 16.1 to 21.8 +/- 12.4% (mean +/- SD, p < 0.01), whereas seven patients showed increased serum albumin levels after treatment.


CONCLUSIONS
These results suggest balloon-occluded retrograde transvenous obliteration increases hepatic portal blood flow, which may be accompanied by improvements in liver function.
Akahane
T
T
Third Department of Internal Medicine, Tohoku University School of Medicine, Aoba-ku, Sendai, Japan.
Iwasaki
T
T
Kobayashi
N
N
Tanabe
N
N
Takahashi
N
N
Gama
H
H
Ishii
M
M
Toyota
T
T
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D003097:Collateral Circulation; D004396:Coloring Agents; D003287:Contrast Media; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green; D007479:Iopamidol; D007668:Kidney / Q000098:blood supply; D008099:Liver / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008102:Liver Circulation; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009829:Oleic Acids / Q000627:therapeutic use; D010865:Pilot Projects; D017082:Portal Pressure; D011168:Portal System / Q000000981:diagnostic imaging / Q000503:physiopathology; D012597:Sclerosing Solutions / Q000627:therapeutic use; D015911:Sclerotherapy / Q000379:methods*; D012709:Serum Albumin / Q000032:analysis; D013270:Stomach / Q000098:blood supply; D018608:Ultrasonography, Doppler
D004396:Coloring Agents; D003287:Contrast Media; D009829:Oleic Acids; D012597:Sclerosing Solutions; D012709:Serum Albumin; D007208:Indocyanine Green; D007479:Iopamidol; C033343:ethanolamine oleate