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Hemodynamic effects of combined therapy using partial splenic embolization and transjugular retrograde obliteration for gastric varices with gastrorenal shunt.
World J Surg. 2010 May; 34(5):1046-51.WJ

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.

PATIENTS AND 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+Show Affiliations

Department of Surgery, Kuniyoshi Hospital, 1-3-4 Kamimachi, Kochi, 780-0901, Japan. chikamo1@i-kochi.or.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20162282

Citation

Chikamori, Fumio, et al. "Hemodynamic Effects of Combined Therapy Using Partial Splenic Embolization and Transjugular Retrograde Obliteration for Gastric Varices With Gastrorenal Shunt." World Journal of Surgery, vol. 34, no. 5, 2010, pp. 1046-51.
Chikamori F, Inoue A, Okamoto H, et al. Hemodynamic effects of combined therapy using partial splenic embolization and transjugular retrograde obliteration for gastric varices with gastrorenal shunt. World J Surg. 2010;34(5):1046-51.
Chikamori, F., Inoue, A., Okamoto, H., Kuniyoshi, N., Kawashima, T., & Takase, Y. (2010). Hemodynamic effects of combined therapy using partial splenic embolization and transjugular retrograde obliteration for gastric varices with gastrorenal shunt. World Journal of Surgery, 34(5), 1046-51. https://doi.org/10.1007/s00268-010-0451-2
Chikamori F, et al. Hemodynamic Effects of Combined Therapy Using Partial Splenic Embolization and Transjugular Retrograde Obliteration for Gastric Varices With Gastrorenal Shunt. World J Surg. 2010;34(5):1046-51. PubMed PMID: 20162282.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hemodynamic effects of combined therapy using partial splenic embolization and transjugular retrograde obliteration for gastric varices with gastrorenal shunt. AU - Chikamori,Fumio, AU - Inoue,Atsushi, AU - Okamoto,Hiroshi, AU - Kuniyoshi,Nobutoshi, AU - Kawashima,Takahiko, AU - Takase,Yasuhiro, PY - 2010/2/18/entrez PY - 2010/2/18/pubmed PY - 2010/7/16/medline SP - 1046 EP - 51 JF - World journal of surgery JO - World J Surg VL - 34 IS - 5 N2 - 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. PATIENTS AND 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. SN - 1432-2323 UR - https://www.unboundmedicine.com/medline/citation/20162282/Hemodynamic_effects_of_combined_therapy_using_partial_splenic_embolization_and_transjugular_retrograde_obliteration_for_gastric_varices_with_gastrorenal_shunt_ L2 - https://dx.doi.org/10.1007/s00268-010-0451-2 DB - PRIME DP - Unbound Medicine ER -