Vang J

Transhepatic Catheterization and Obliteration of the Coronary Vein in Patients with Portal Hypertension and Esophageal Varices

Abstract For the management of esophageal varices complicating portal hypertension, we have developed a method that consists of (1) percutaneous transhepatic portal venipuncture, (2) manipulation of a catheter via the portal vein into the coronary vein, and, (3) if injection of contrast medium demonstrates retrograde flow through that vein as well as esophageal varices, injection of 30 ml of 50 per cent glucose solution followed by injection of a small amount of thrombin solution. Portography is used throughout to facilitate the procedure and assess results. Four patients have been treated, two of them with variceal bleeding. In all four, obliteration of the coronary vein by this method was successful. (N Engl J Med 291:646–649, 1974)

Chronic Hepatic Encephalopathy. A Psychometrical Study

Psychometric tests were performed in 41 patients with cirrhosis of the liver and suspected hepatic encephalopathy and compared with EEG-examinations and clinical investigations. Marked intellectual impairment was noted frequently even when the clinical investigation was normal. This difference was mainly due to the preserved verbal ability of the patient. The etiology of the cirrhosis did not influence the test results. Male cirrhotic patients with and without alcoholism showed significantly more intellectual impairment then alcoholics without cirrhosis. Patients Patients with constructed porto-systemic shunts showed only slightly reduced intellectual ability compared to those without shunts.

Follow-up of Patients with Portal Hypertension and Esophageal Varices Treated with Percutaneous Obliteration of Gastric Coronary Vein

Percutaneous transhepatic catheterization of the portal vein was performed in 21 patients with liver cirrhosis and esophageal varices. Coronary and short gastric veins were selectively catheterized and obliterated. The examination was performed to stop bleeding in 6 patients and was successful in 5. Follow-up examination showed recanalization of previously obliterated veins in 13 of 16 patients.

Results of a modified distal spleno renal shunt for portal hypertension

Twenty-five patients were treated with a distal spleno-renal shunt modified after that of Warren. The operative mortality was 4/25. One patient had an early thrombosis. All post-operative angiography otherwise showed patent shunts. After a median observation time of 43 months, 10/20 patients included in the followup were dead. The chief cause of death was liver failure. Encephalopathy has been common although generally of minor degree. Hypersplenism, judged by thrombocyte count, was not significantly affected by the operation. Six of 21 patients have had gastrointestinal hemorrhage after the operation but no hemorrhage proved fatal. Postoperatively esophageal varices size was considerably diminished in most cases as judged by contrast x-ray. Ascites has not been a problem in this series. Postoperative angiography showed a marked and rapid reduction of portal blood flow to the liver with progressively more blood deviated through the coronary vein towards the shunt. This reduction in portal flow is a possible explanation of the high frequency of postoperative liver failure. This version of the distal spleno-renal shunt has probably no advantages over the portacaval shunt.

Hemodynamic Changes after Distal Splenorenal Shunt Studied by Sequential Angiography

Distal splenorenal shunts were made in 25 patients with cirrhosis of the liver and portal hypertension. Angiograms were obtained in 16 patients at one week, three and six months, and at one year postoperatively. Portal vein flow had diminished in all patients compared with flow seen in preoperative angiograms. Hepatofugal flow developed in 6 patients during the follow-up period, and in 2 patients only one week postoperatively. The shunt remained patent in all of the patients but one.