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

P Gostner, C Fugazzola, F Martin

    Rofo : Fortschritte Auf Dem Gebiete Der Rontgenstrahlen Und Der Nuklearmedizin
    |June 1, 1986
    PubMed
    Summary

    The Warren procedure for portal hypertension does not allow selective drainage of the portal venous system. Postoperative hepatofugal circulation develops over time and varies among patients, impacting liver blood flow.

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    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.

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  • 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.