title: Detection of paraumbilical or splenorenal shunts by intra-arterial-DSA in bleeding varices: another risk factor?
abstract: In six of 46 consecutive patients with liver cirrhosis and bleeding varices, selective intra-arterial digital subtraction angiography detected large spontaneous portosystemic shunts including three patent paraumbilical veins and three splenorenal shunts. Twenty-one patients died during a median 73-month follow up period after devascularization with (44 cases) or without (2 cases) esophageal transection. Univariate analysis of preoperative variables concerning hepatic reserve failed to show significant predictability on postoperative survival rate. Instead, the postoperative survival rate of patients with the decompressive shunts was significantly lower than that of patients without the shunt. In a subgroup of patients with well-compensated liver cirrhosis and bleeding varices, the coexistence of paraumbilical or splenorenal portosystemic shunt may be another potent variable predicting poor prognosis.
authors.affiliation: Department of Radiology, Iwate Medical University, Morioka, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Nakamura
authors.forename: A
authors.initials: A
authors.lastname: Hirose
authors.forename: T
authors.initials: T
authors.lastname: Nakasato
authors.forename: K
authors.initials: K
authors.lastname: Yoshioka
authors.forename: M
authors.initials: M
authors.lastname: Sasaki
authors.forename: Y
authors.initials: Y
authors.lastname: Tamakawa
authors.forename: A
authors.initials: A
authors.lastname: Sasaki
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D003287:Contrast Media; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D006801:Humans; D007479:Iopamidol; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011379:Prognosis; D012039:Regional Blood Flow; D012077:Renal Artery / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012307:Risk Factors; D013157:Splenic Artery / Q000000981:diagnostic imaging*; D014472:Umbilicus / Q000098:blood supply* / Q000000981:diagnostic imaging
chemical_list: D003287:Contrast Media; D007479:Iopamidol