title: Hemodynamic effects of combined therapy using partial splenic embolization and transjugular retrograde obliteration for gastric varices with gastrorenal shunt.
abstract: BACKGROUND
  The purpose of the present study was to investigate the short-term effects of combined therapy using partial splenic embolization (PSE) and transjugular retrograde obliteration (TJO) on the portal hemodynamics of gastric varices with a gastrorenal shunt.
  
  
  METHODS
  Sixteen patients with gastric varices and a gastrorenal shunt were included in this study. Partial splenic embolization was applied 2 weeks before TJO. The portal blood flow was measured by an ultrasonic duplex Doppler system, and the wedged hepatic venous pressure (WHVP) was measured by hepatic venous catheterization, before and after the combined therapy.
  
  
  RESULTS
  The complete obliteration of the gastrorenal shunt and gastric varices was revealed by retrograde shuntography and computed tomography after TJO in all cases. The WHVP before and just after PSE was 23 +/- 7 and 19 +/- 7 mmHg, respectively, showing a significant change (P < 0.01). The WHVP before and the day after TJO was 20 +/- 5 mmHg and 22 +/- 6 mmHg, respectively, showing a significant change (P < 0.01). There was no significant difference between the WHVP before and after the combined therapy. The portal venous flow volume before and after the combined therapy were 514 +/- 146 and 512 +/- 161 ml/min, respectively, showing no significant change. However, the splenic venous flow volume before and after the combined therapy was 319 +/- 131 and 179 +/- 113 ml/min, respectively, showing a significant change (P < 0.05).
  
  
  CONCLUSIONS
  The WHVP did not change after the combined therapy of PSE and TJO. Partial splenic embolization contributed to protecting portal congestion after TJO. We conclude that the combined therapy using PSE and TJO is an effective treatment for gastric varices from the portal hemodynamic point of view.
authors.affiliation: Department of Surgery, Kuniyoshi Hospital, 1-3-4 Kamimachi, Kochi, 780-0901, Japan. chikamo1@i-kochi.or.jp
authors.forename: Fumio
authors.initials: F
authors.lastname: Chikamori
authors.forename: Atsushi
authors.initials: A
authors.lastname: Inoue
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okamoto
authors.forename: Nobutoshi
authors.initials: N
authors.lastname: Kuniyoshi
authors.forename: Takahiko
authors.initials: T
authors.lastname: Kawashima
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takase
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011168:Portal System / Q000503:physiopathology*; D011170:Portasystemic Shunt, Surgical; D013157:Splenic Artery