[Portal circulation following Warren's operation. Long-term control using computerized tomography]

Area of Science:

• Hepatology
• Vascular Surgery
• Radiology

Background:

• Portal hypertension, often caused by liver cirrhosis, presents significant clinical challenges.
• The Warren procedure is a surgical intervention aimed at decompressing the portal venous system.
• Long-term outcomes and hemodynamic changes following the Warren procedure require further investigation.

Purpose of the Study:

• To evaluate the long-term effects of the Warren procedure on portal circulation using computed tomography.
• To assess the pressure dynamics and collateral circulation after surgical decompression for portal hypertension.
• To understand the temporal evolution and variability of hepatofugal circulation post-surgery.

Main Methods:

• Computed tomography (CT) with contrast injection was performed on 18 patients.
• Patients had previously undergone a Warren procedure for liver cirrhosis-induced portal hypertension (>5 years prior).
• Analysis focused on portal venous territory drainage, pressure gradients, and collateral formation.

Main Results:

• Selective drainage of specific portal venous territories was not achievable.
• The portal circulation does not operate as two distinct portions with differing pressures.
• A greater pressure difference was observed across the splenorenal anastomosis compared to mediastinal veins.
• Postoperative hepatofugal circulation developed and persisted long-term, not limited to the early phase.
• Significant variations were noted in the extent of collateral circulation and the maintenance of liver blood flow.

Conclusions:

• The Warren procedure does not permit isolated drainage of portal venous territories.
• Hepatofugal circulation is a prolonged, variable, and non-uniform consequence of the Warren procedure.
• These hemodynamic changes can influence the maintenance of adequate liver blood flow over extended periods.