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Differential effects on portal and effective hepatic blood flow. A comparison between transjugular intrahepatic portasystemic shunt and small-diameter H-graft portacaval shunt.
Ann Surg. 1997 May; 225(5):601-7; discussion 607-8.AnnS

Abstract

OBJECTIVE

This study was undertaken to determine the effects of transjugular intrahepatic portasystemic shunt (TIPS) and small-diameter prosthetic H-graft portacaval shunt (HGPCS) on portal and effective hepatic blood flow.

SUMMARY BACKGROUND DATA

Mortality after TIPS is higher than after HGPCS for bleeding varices. This higher mortality is because of hepatic failure, possibly a result of excessive diminution of hepatic blood flow.

METHODS

Forty patients randomized prospectively to undergo TIPS or HGPCS had effective hepatic blood flow determined 1 day preshunt and 5 days postshunt using low-dose galactose clearance. Portal blood flow was determined using color-flow Doppler ultrasound.

RESULTS

Treatment groups were similar in age, gender, and Child's class. Each procedure significantly reduced portal pressures and portasystemic pressure gradients. Portal flow after TIPS increased (21 mL/second +/- 11.9 to 31 mL/second +/- 16.9, p < 0.05), whereas it remained unchanged after HGPCS (26 mL/second +/- 27.7 to 14 mL/second +/- 41.1, p = n.s.). Effective hepatic blood flow was diminished significantly after TIPS (1684 mL/minute +/- 2161 to 676 mL/minute +/- 451, p < 0.05) and was unaffected by HGPCS (1901 mL/ minute +/- 1818 to 1662 mL/minute +/- 1035, p = n.s.).

CONCLUSIONS

Both TIPS and HGPCS achieved significant reductions in portal vein pressure gradients. Portal flow increased after TIPS, although most portal flow was diverted through the shunt. Effective hepatic flow is reduced significantly after TIPS but well preserved after HGPCS. Hepatic decompensation and mortality after TIPS may be because, at least in part, of reductions in nutrient hepatic flow.

Authors+Show Affiliations

Department of Surgery, University of South Florida, Tampa, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

9193187

Citation

Rosemurgy, A S., et al. "Differential Effects On Portal and Effective Hepatic Blood Flow. a Comparison Between Transjugular Intrahepatic Portasystemic Shunt and Small-diameter H-graft Portacaval Shunt." Annals of Surgery, vol. 225, no. 5, 1997, pp. 601-7; discussion 607-8.
Rosemurgy AS, Zervos EE, Goode SE, et al. Differential effects on portal and effective hepatic blood flow. A comparison between transjugular intrahepatic portasystemic shunt and small-diameter H-graft portacaval shunt. Ann Surg. 1997;225(5):601-7; discussion 607-8.
Rosemurgy, A. S., Zervos, E. E., Goode, S. E., Black, T. J., & Zwiebel, B. R. (1997). Differential effects on portal and effective hepatic blood flow. A comparison between transjugular intrahepatic portasystemic shunt and small-diameter H-graft portacaval shunt. Annals of Surgery, 225(5), 601-7; discussion 607-8.
Rosemurgy AS, et al. Differential Effects On Portal and Effective Hepatic Blood Flow. a Comparison Between Transjugular Intrahepatic Portasystemic Shunt and Small-diameter H-graft Portacaval Shunt. Ann Surg. 1997;225(5):601-7; discussion 607-8. PubMed PMID: 9193187.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Differential effects on portal and effective hepatic blood flow. A comparison between transjugular intrahepatic portasystemic shunt and small-diameter H-graft portacaval shunt. AU - Rosemurgy,A S, AU - Zervos,E E, AU - Goode,S E, AU - Black,T J, AU - Zwiebel,B R, PY - 1997/5/1/pubmed PY - 1997/5/1/medline PY - 1997/5/1/entrez SP - 601-7; discussion 607-8 JF - Annals of surgery JO - Ann Surg VL - 225 IS - 5 N2 - OBJECTIVE: This study was undertaken to determine the effects of transjugular intrahepatic portasystemic shunt (TIPS) and small-diameter prosthetic H-graft portacaval shunt (HGPCS) on portal and effective hepatic blood flow. SUMMARY BACKGROUND DATA: Mortality after TIPS is higher than after HGPCS for bleeding varices. This higher mortality is because of hepatic failure, possibly a result of excessive diminution of hepatic blood flow. METHODS: Forty patients randomized prospectively to undergo TIPS or HGPCS had effective hepatic blood flow determined 1 day preshunt and 5 days postshunt using low-dose galactose clearance. Portal blood flow was determined using color-flow Doppler ultrasound. RESULTS: Treatment groups were similar in age, gender, and Child's class. Each procedure significantly reduced portal pressures and portasystemic pressure gradients. Portal flow after TIPS increased (21 mL/second +/- 11.9 to 31 mL/second +/- 16.9, p < 0.05), whereas it remained unchanged after HGPCS (26 mL/second +/- 27.7 to 14 mL/second +/- 41.1, p = n.s.). Effective hepatic blood flow was diminished significantly after TIPS (1684 mL/minute +/- 2161 to 676 mL/minute +/- 451, p < 0.05) and was unaffected by HGPCS (1901 mL/ minute +/- 1818 to 1662 mL/minute +/- 1035, p = n.s.). CONCLUSIONS: Both TIPS and HGPCS achieved significant reductions in portal vein pressure gradients. Portal flow increased after TIPS, although most portal flow was diverted through the shunt. Effective hepatic flow is reduced significantly after TIPS but well preserved after HGPCS. Hepatic decompensation and mortality after TIPS may be because, at least in part, of reductions in nutrient hepatic flow. SN - 0003-4932 UR - https://www.unboundmedicine.com/medline/citation/9193187/Differential_effects_on_portal_and_effective_hepatic_blood_flow__A_comparison_between_transjugular_intrahepatic_portasystemic_shunt_and_small_diameter_H_graft_portacaval_shunt_ L2 - https://Insights.ovid.com/pubmed?pmid=9193187 DB - PRIME DP - Unbound Medicine ER -