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Portal vein embolization (PVE) is a preoperative procedure performed in interventional radiology to initiate hypertrophy of the anticipated future liver remnant a couple weeks prior to a major liver resection procedure. The procedure involves injecting the right or left portal vein with embolic material to occlude portal blood flow.
By creating a shunt from the portal vein to the hepatic vein, this intervention allows portal blood an alternative avenue for draining into systemic circulation. In bypassing the flow-resistant liver, the net result is a reduced pressure drop across the liver and a decreased portal venous pressure. Decreased portal venous pressure in turn ...
A dilated portal vein (diameter of greater than 13 or 15 mm) is a sign of portal hypertension, with a sensitivity estimated at 12.5% or 40%. [8] On Doppler ultrasonography , the main portal vein (MPV) peak systolic velocity normally ranges between 20 cm/s and 40 cm/s. [ 9 ]
The circulation of a patient after BDG shunt placement requires adequate systemic venous return to support pulmonary blood flow. However, pulmonary blood flow, and thus oxygenation, is inhibited by high pressures or valvular obstructions. [1] Pulmonary hypertension (moderate to severe) is a relative contraindication to the bidirectional Glenn. [5]
For example, in portal hypertension, there is an abnormal portal venous flow where it flows away from the liver (hepatofugal flow) instead of the normal flow towards liver (hepatopetal flow). In jugular venous pressure waveform of the internal jugular vein , the retrograde "a" waveform is a normal flow due to right atrium contraction.
Portal hypertension is commonly seen with liver cirrhosis and/or other liver diseases such as Budd–Chiari syndrome, primary biliary cirrhosis (PBC), and portal vein thrombosis. [2] The purpose of the shunt is to divert blood flow away from the liver, reducing the high pressure in the portal venous system and decreasing the risk of bleeding. [3]
The human hepatic portal system delivers about three-fourths of the blood going to the liver.The final common pathway for transport of venous blood from spleen, pancreas, gallbladder and the abdominal portion of the gastrointestinal tract [2] (with the exception of the inferior part of the anal canal and sigmoid colon) is through the hepatic portal vein.
A dilated portal vein (diameter of greater than 13 or 15 mm) is a sign of portal hypertension, with a sensitivity estimated at 12.5% or 40%. [18] On Doppler ultrasonography, a slow velocity of <16 cm/s in addition to dilatation in the main portal vein are diagnostic of portal hypertension. [19]