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Portosystemic collateral pathways and interventions in portal hypertension

Murad Feroz Bandali|Anirudh Mirakhur
소화기인터벤션의학회 (The Society of Gastrointestinal Intervention)|2018.04|International Journal of Gastrointestinal Intervention|제7권 제1호|pp. 21-28

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참고문헌

키워드

HypertensionportalRadiologyPortal hypertensioninterventionalVarices

초록

Pathologic increase in portal pressure can be caused by increased resistance to blood flow at the level of the portal vein (pre-hepatic), hepatic sinusoids (hepatic) or hepatovenous outflow (post-hepatic). This results in recruitment and dilatation of tiny portosystemic collateral pathways, diverting portal venous blood flow to low pressure systemic veins. Based on the location of the causative factor of portal venous resistance, different collateral pathways and shunts may develop, resulting in unique syndromes of portal hypertension and in-turn requiring unique treatment options. Knowledge of the common and less-common portosystemic collateral pathways have important implication for clinicians and interventionalists. The objective of this pictorial review is to illustrate the various collateral pathways using diagrammatic and conventional non-invasive and invasive radiologic examples. Additionally, we will briefly address minimally invasive interventional techniques used to treat the sequelae of portal hypertension.

Abstract

Pathologic increase in portal pressure can be caused by increased resistance to blood flow at the level of the portal vein (pre-hepatic), hepatic sinusoids (hepatic) or hepatovenous outflow (post-hepatic). This results in recruitment and dilatation of tiny portosystemic collateral pathways, diverting portal venous blood flow to low pressure systemic veins. Based on the location of the causative factor of portal venous resistance, different collateral pathways and shunts may develop, resulting in unique syndromes of portal hypertension and in-turn requiring unique treatment options. Knowledge of the common and less-common portosystemic collateral pathways have important implication for clinicians and interventionalists. The objective of this pictorial review is to illustrate the various collateral pathways using diagrammatic and conventional non-invasive and invasive radiologic examples. Additionally, we will briefly address minimally invasive interventional techniques used to treat the sequelae of portal hypertension.

참고문헌 (45)

  1. Berzigotti A, "Assessing portal hypertension in liver diseases", Expert Rev Gastroenterol Hepatol, 7, pp.141~155 (2013)
  2. Bosch J, "Evolution in the understanding of the pathophysiological basis of portal hypertension: how changes in paradigm are leading to successful new treatments", J Hepatol, 62(1 Suppl), pp.S121~S130 (2015)
  3. Wachsberg RH, "Cardiophrenic varices in portal hypertension : evaluation with CT", Radiology, 195, pp.553~556 (1995)
  4. Bosch J, "The clinical use of HVPG measurements in chronic liver disease", Nat Rev Gastroenterol Hepatol, 6, pp.573~582 (2009)
  5. Bosch J, "Hepatic endothelial dysfunction and abnormal angiogenesis : new targets in the treatment of portal hypertension", J Hepatol, 53, pp.558~567 (2010)
  6. Bosch J, "Portal hypertension", Med Clin North Am, 73, pp.931~953 (1989)
  7. Thabut D, "Intrahepatic angiogenesis and sinusoidal remodeling in chronic liver disease: new targets for the treatment of portal hypertension", J Hepatol, 53, pp.976~980 (2010)
  8. Kim YJ, "Esophageal varices in cirrhotic patients: evaluation with liver CT", AJR Am J Roentgenol, 188, pp.139~144 (2007)
  9. Lee SJ, "Computed radiography of the chest in patients with paraesophageal varices : diagnostic accuracy and characteristic findings", AJR Am J Roentgenol, 170, pp.1527~1531 (1998)
  10. Arora A, "Spectrum of hepatofugal collateral pathways in portal hypertension : an illustrated radiological review", Insights Imaging, 6, pp.559~572 (2015)
  11. Cho KC, "Varices in portal hypertension : evaluation with CT", RadioGraphics, 15, pp.609~622 (1995)
  12. Stankovic Z, "Normal and altered three-dimensional portal venous hemodynamics in patients with liver cirrhosis", Radiology, 262, pp.862~873 (2012)
  13. Lafortune M, "Portal venous system measurements in portal hypertension", Radiology, 151, pp.27~30 (1984)
  14. Subramanyam BR, "Sonography of portosystemic venous collaterals in portal hypertension", Radiology, 146, pp.161~166 (1983)
  15. Wachsberg RH, "Coronary vein diameter and flow direction in patients with portal hypertension : evaluation with duplex sonography and correlation with variceal bleeding", AJR Am J Roentgenol, 162, pp.637~641 (1994)
  16. Garcia-Tsao G, "Current management of the complications of cirrhosis and portal hypertension : variceal hemorrhage, ascites, and spontaneous bacterial peritonitis", Gastroenterology, 120, pp.726~748 (2001)
  17. Takashi M, "Esophageal varices : correlation of left gastric venography and endoscopy in patients with portal hypertension", Radiology, 155, pp.327~331 (1985)
  18. Lin CY, "Influence of paraesophageal venous collaterals on efficacy of endoscopic sclerotherapy for esophageal varices", Hepatology, 19, pp.602~608 (1994)
  19. Gluud LL, "Banding ligation versus betablockers as primary prophylaxis in esophageal varices: systematic review of randomized trials", Am J Gastroenterol, 102, pp.2842~2848 (2007)
  20. Kirby JM, "Image-guided intervention in management of complications of portal hypertension : more than TIPS for success", Radiographics, 33, pp.1473~1496 (2013)
  21. Zheng M, "Transjugular intrahepatic portosystemic shunt versus endoscopic therapy in the secondary prophylaxis of variceal rebleeding in cirrhotic patients : meta-analysis update", J Clin Gastroenterol, 42, pp.507~516 (2008)
  22. Narahara Y, "Transjugular intrahepatic portosystemic shunt versus paracentesis plus albumin in patients with refractory ascites who have good hepatic and renal function : a prospective randomized trial", J Gastroenterol, 46, pp.78~85 (2011)
  23. García-Pagán JC, "Early use of TIPS in patients with cirrhosis and variceal bleeding", N Engl J Med, 362, pp.2370~2379 (2010)
  24. Rössle M, "The transjugular intrahepatic portosystemic stent-shunt procedure for variceal bleeding", N Engl J Med, 330, pp.165~171 (1994)
  25. Petersen BD, "Direct intrahepatic portocaval shunt", Tech Vasc Interv Radiol, 11, pp.230~234 (2008)
  26. Feldman M, "Gastric varices", Gastroenterology, 30, pp.318~321 (1956)
  27. Mitty HA, "Adrenal pseudotumors on CT due to dilated portosystemic veins", AJR Am J Roentgenol, 141, pp.727~730 (1983)
  28. Sharma M, "Collateral pathways in portal hypertension", J Clin Exp Hepatol, 2, pp.338~352 (2012)
  29. Irani S, "Gastric varices : an updated review of management", J Clin Gastroenterol, 45, pp.133~148 (2011)
  30. Saad WE, "Balloon-occluded retrograde transvenous obliteration of gastric varices : conception, evolution, and history", Tech Vasc Interv Radiol, 15, pp.160~164 (2012)
  31. Cho SK, "Balloon-occluded retrograde transvenous obliteration of gastric varices: outcomes and complications in 49 patients", AJR Am J Roentgenol, 189, pp.W365~W372 (2007)
  32. Fukuda T, "Long-term results of balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy", J Vasc Interv Radiol, 12, pp.327~336 (2001)
  33. Ninoi T, "Balloonoccluded retrograde transvenous obliteration of gastric varices with gastrorenal shunt : long-term follow-up in 78 patients", AJR Am J Roentgenol, 184, pp.1340~1346 (2005)
  34. Lee EW, "Coil-Assisted Retrograde Transvenous Obliteration (CARTO) for the treatment of portal hypertensive variceal bleeding: preliminary results", Clin Transl Gastroenterol, 5, pp.e61~ (2014)
  35. Gwon DI, "Vascular plug-assisted retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy : a prospective multicenter study", J Vasc Interv Radiol, 26, pp.1589~1595 (2015)
  36. Morin C, "Patent paraumbilical vein : anatomic and hemodynamic variants and their clinical importance", Radiology, 185, pp.253~256 (1992)
  37. Farghal AS, "Embolization of spontaneous portosystemic shunt for treatment of refractory hepatic encephalopathy", J Vasc Interv Radiol, 24, pp.S27~S28 (2013)
  38. Laleman W, "Embolization of large spontaneous portosystemic shunts for refractory hepatic encephalopathy : a multicenter survey on safety and efficacy", Hepatology, 57, pp.2448~2457 (2013)
  39. Spier BJ, "Bleeding stomal varices : case series and systematic review of the literature", Clin Gastroenterol Hepatol, 6, pp.346~352 (2008)
  40. Saad WE, "Stomal varices : management with decompression tips and transvenous obliteration or sclerosis", Tech Vasc Interv Radiol, 16, pp.176~184 (2013)
  41. Léauté F, "Massive hemoperitoneum from rupture of an intra-peritoneal varix", J Radiol, 83, pp.1775~1777 (2002)
  42. Bataille L, "Spontaneous rupture of omental varices : an uncommon cause of hypovolemic shock in cirrhosis", Acta Gastroenterol Belg, 67, pp.351~354 (2004)
  43. Okuda K, "Portal hypertension: clinical and physiological aspects", pp.51~62 (1991), Springer Japan
  44. Malde H, "Detection of rectal and pararectal varices in patients with portal hypertension : efficacy of transvaginal sonography", AJR Am J Roentgenol, 161, pp.335~337 (1993)
  45. Kim M, "Portosystemic collaterals of the upper abdomen : review of anatomy and demonstration on MR imaging", Abdom Imaging, 25, pp.462~470 (2000)

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