| BackgroundPortosystemic collateral vessels(PSCV)develop usually in patients with cirrhosis and portal hypertension.The flow within the PSCV is always away from the liver.The amount and blood flow of PSCV increase with the development of portal hypertension.PSCV is an important cause of variceal bleeding and hepatic encephalopathy.Identification of the origin of the PSCV and where it flows to is of paramount importance.Currently,several classifications based on CT scan of PSCV have been proposed.However,enhancement CT cannot show the hemodynamics correctly.There is no systematic research of the DSA manifestations through TIPS.Therefore,this study observed the manifestations of digital subtraction angiography which was performed by catheterizing the portal vein directly through TIPS and the clinical significance of the common PSCV.PurposeTo observe the manifestations of digital subtraction angiography which was performed by catheterizing the portal vein directly through TIPS and the clinical significance of the common PSCV.Materials and methodsMaterials:This retrospective study evaluated patients with decompensated cirrhosis and portal hypertension who were treated with TIPS between August 2015 and February 2017.According to the inclusion and exclusion criteria,a total of 274 patients(232 men and 42 women;mean age 51.29±12.63)were subordinated to our study.The preoperative evaluation of liver function was based on the Child-Pugh classification.32 patients with Child-Pugh Class A,175 patients with Child-Pugh Class B and 67 patients with Child-Pugh Class C.Methods1.Digital subtraction angiography was performed by catheterizing the superior mesenteric vein and splenic vein directly through TIPS,respectively.2.Manifestations of digital subtraction angiography of PSCV were observed.3.To find out the clinical significance of PSCV by analyzing the manifestations of digital subtraction angiography of PSCV and some of the clinical parameters.Preoperative liver function,ascites levels and PVP pressure were recorded.Combine with the part PSCV to analyze the relationship with the preoperative clinical indicators by statistics.To analyze the relationship between the emerging of PSCV and preoperative liver function,ascites levels and PVP pressure by using Chi-square testThe analysis of variance(ANOVA)was used in measurement data.The Chi-square test was used in enumeration data to compare between the groups.Statistical significance was achieved when the P value was less than 0.05.ResultsThe success rate of TIPS and photography of the superior mesenteric vein and splenic vein in a total of 274 patients was 100%.All but 6 patients who were presented with stenosis or occlusive right internal jugular vein used left internal jugular vein approach.No postoperative complications occurred,such as intra-abdominal hemorrhage,puncture site bleeding.1.Descriptive research on manifestations of DSA of PSCVAccording to the origin of PSCV in portal,the PSCV can be divided into four types:(1)Origin from branch of portal vein(2.55%),(2)Origin from main portal vein(23.35%),(3)Origin from tributaries of the portal vein(include superior/inferior mesenteric vein and splenic vein)(12.77%),(4)Multi-originals,that is,PSCV origin from two or more site mentioned above.Different PSCV appear as follows:1.1 Origin from branch of portal vein in 75 cases(1)Left branch of portal vein:Paraumbilical vein in 42 cases(15.33%),left branch of portal vein-phrenic/gastro in 4 cases(1.46%)(2)The end of portal vein:extensive intrahepatic shunts between the ending portal veins and hepatic veins in 29 cases(10.58%).1.2 Origin from main portal vein in 216 casesLeft gastric varices in 216 cases(78.83%).1.3 Origin from tributaries of the portal vein in 188 cases(1)Short/Posterior gastric veins in 172 cases(62.77%)(2)Superior mesenteric vein(SMV):SMV-Retroperitoneal varices in 1 case(0.36%),SMV-gastric fundus varices in 1 cases(0.36%),gastroepiploic varices in 5 cases(1.82%)(3)Inferior mesenteric vein:rectal varices in 2 cases(0.73%)(4)Spleno/Gastro-renal shunt in 23 cases(8.39%)1.4 Multi-originals in 168 casesLeft gastric vein combines the other veins in 141 cases(51.46%),Short/Posterior gastric veins combines the other veins in 130 cases(47.45%).And paraumbilical vein,the end of portal vein,spleno/Gastro-renal shunt etc.with two or more than two sources of the above veins.2.The clinical significance of the common PSCV(1)There was a significant difference in the frequency of Left gastric varices,short/posterior gastric veins and paraumbilical vein in different levels of the liver function Child-Pugh classification,PVP and ascites levels(P<0.05).(2)There was no significant difference in frequency of Spleno/Gastro-renal shunt in different levels of the liver function Child-Pugh classification,PVP and ascites levels(P>0.05).(3)There was no significant difference in frequency of extensive intrahepatic shunts between the ending portal veins and hepatic veins in different levels of PVP and ascites levels(P<0.05).And it only appeared in patients with Child-Pugh B-C of liver function.Conclusion1.Portal vein photography in TIPS is safe and feasible.2.The PSCV can be divided into four types base on it’s origin under the DSA manifestations:branch of portal vein,the main portal vein,tributaries of the portal vein and multi-sources type.Most of the PSCV is multi-sources type(61.31%)and the extensive intrahepatic shunts between the ending portal veins and hepatic veins could be found at this type.3.The frequency of Left gastric varices,short/posterior gastric veins and paraumbilical vein increase with the increase of the Child-Pugh classification of liver function,PVP and ascites levels.4.There was no correlation between the frequency of spleno/Gastro-renal shunt and the Child-Pugh classification of liver function,PVP and ascites levels.Similar results are obtained in extensive intrahepatic shunts between the ending portal veins and hepatic veins.5.The extensive intrahepatic shunts between the ending portal veins and hepatic veins appears in the patient with Child-Pugh B-C of liver function. |
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