title: Effects of combined therapy using partial splenic embolization and transjugular retrograde obliteration on systemic hemodynamics in patients with gastric varices and a splenorenal shunt.
abstract: OBJECTIVE
  The purpose of this study was to investigate the effects of combined therapy using partial splenic embolization (PSE) and transjugular retrograde obliteration (TJO) on the systemic hemodynamics of gastric varices with a splenorenal shunt.
  
  
  METHODS
  Eleven patients having gastric varices with a splenorenal shunt were included in this study. PSE was applied 2 weeks before TJO. Systemic hemodynamic studies were performed before and 22 ± 12 months after the combined therapy.
  
  
  RESULTS
  Complete obliteration of the splenorenal shunt and gastric varices was revealed by retrograde shuntography and computed tomography after TJO in all cases. The cardiac index (1/min/m2) before and after the combined therapy was 3.98 ± 0.85 and 4.05 ± 0.78, respectively. The systemic vascular resistance index (dynes s/cm5/m2) before and after the combined therapy was 1887 ± 450 and 1837 ± 4621, respectively. They showed no significant change. The arterio-venous oxygen content difference (vol%) before and after the combined therapy was 2.55 ± 0.55 and 3.21 ± 0.90, respectively, showing a significant change (P<0.05). The splenic venous flow volume before and after the combined therapy was 307 ± 158 and 166 ± 78 mL/min, respectively, showing a significant change (P<0.05).
  
  
  CONCLUSIONS
  : We conclude that the combined therapy using PSE and TJO reduces the splenic venous flow and stops the splenorenal shunt flow, which improves the arterio-venous oxygen content difference.
authors.affiliation: Department of Surgery, Kuniyoshi Hospital, Kochi, Japan. chikamo2300@gmail.com
authors.forename: Fumio
authors.initials: F
authors.lastname: Chikamori
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okamoto
authors.forename: Nobutoshi
authors.initials: N
authors.lastname: Kuniyoshi
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takase
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment; D013154:Spleen; D013164:Splenorenal Shunt, Surgical; D016896:Treatment Outcome