[A clinical and portal hemodynamic analysis for obliteration of gastric-renal shunt communicated with gastric fundic varices].
To clear the efficacy of treatment for large porto-systemic shunts, changes of liver function and portal hemodynamics after obliteration of gastric-renal shunt (GRS) or gastric-inferior phrenic vein shunt (GIS) communicated with gastric fundic varies in 24 patients treated with balloon-occluded retrograde transvenous obliteration (B-RTO) were studied. 1) The wedged hepatic venous pressure and the hepatic venous pressure gradient were statistically not significant changed after obliteration of GRS or GIS. 2) Serum albumin value was significantly increased (p < 0.005) and ICGR15 was significantly improved (p < 0.005) at one year after treatment in patients that, not only whose GRS or GIS were larger than 10mm in diameter, but also whose superior mesenteric arterial venography before treatment showed hepatofugal flow. 3) At a mean follow-up abdominal angiography of 23.3 months in 20 cases, GRS or GIS was yet obliterated respectively. And more, superior mesenteric arterial venography revealed hepatopetal flow alone in 43% of patients that, whose superior mesenteric arterial venography before treatment showed hepatofugal flow. 4) During a mean follow-up of 32.5 months, gastric fundic varies were not recurrent in all patients, but the other hand, cumulative red color sign positive esophageal varies apparent rates were high (16.7% at before treatment, 38.4% at 2-years, 54.4% at 4-years). According to their hemodynamic characteristics, cumulative red color sign positive esophageal varies apparent rates in patients with another collaterals besides GRS or GIS before treatment (26.7% at before treatment, 61.1% at 2-years, 74.1% at 4-years) were significantly higher (p < 0.05) than those in patients without another collateral except GRS or GIS (0% at 2-years, 16.7% at 4-years). We conclude that, 1) Increment of portal flom and improvement of liver function can be expected by obliteration of GRS or GIS in patients that, whose superior mesenteric venous blood flow into large GRS or GIS. 2) After obliteration of GRS or GIS, the incidence of aggravation of esophageal varies in patients with another collaterals besides GRS or GIS before treatment is high, while that in cases without another collateral is low.
Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital.
S
S
Hayashi
S
S
Saeki
H
H
Hosoi
T
T
Tanaka
T
T
Shibayama
H
H
Ootake
T
T
Ushimi
Y
Y
Yokoyama
N
N
Kamata
S
S
Tanaka
D000328:Adult; D000368:Aged; D002404:Catheterization; D003097:Collateral Circulation; D004932:Esophageal and Gastric Varices / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008099:Liver / Q000503:physiopathology*; D008102:Liver Circulation; D008297:Male; D008875:Middle Aged; D011168:Portal System / Q000502:physiology*; D011170:Portasystemic Shunt, Surgical