Color Doppler velocity profile assessment of portal hemodynamics in cirrhotic patients with portal hypertension: Correlation with esophageal variceal bleeding
✍ Scribed by Xiao-Yu Yin; Ming-De Lu; Jie-Fu Huang; Xiao-Yan Xie; Li-Jian Liang
- Publisher
- John Wiley and Sons
- Year
- 2001
- Tongue
- English
- Weight
- 519 KB
- Volume
- 29
- Category
- Article
- ISSN
- 0091-2751
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✦ Synopsis
Purpose:
Using the color doppler velocity profile (cdvp), we investigated portal hemodynamics and their relationship with esophageal variceal bleeding (evb) in patients with cirrhosis and portal hypertension.
Methods:
The hemodynamics of the portal trunk, right anterior portal branch, and splenic vein were evaluated in 69 cirrhotic patients with portal hypertension and 46 healthy volunteers. the cdvp, a recently developed doppler software, was used to measure blood flow velocity and flow volume; evaluate the spatial distribution of flow velocities in the cross-section of a vessel (velocity profile), as reflected by the profile parameter (n); and assess changes in flow volume over time (flow profile). the congestion index was calculated by dividing the cross-sectional area by the maximum cross-sectional velocity (csvmax). the hemodynamic features were compared between patients without a history of evb [evb(-)] and those with a history of evb [evb(+)], and a logistic regression model was employed to identify factors associated with evb.
Results:
Compared with the healthy group, the cirrhotic group had a significantly lower mean csvmax in the portal trunk and right anterior portal branch (both p < 0.01), a significantly elevated mean flow volume in the splenic vein and portal trunk (both p < 0.01), a significantly elevated mean ratio of splenic vein flow volume to portal trunk flow volume (sv/pt) (p < 0.001), and a significantly greater mean congestion index in the portal trunk, right anterior portal branch, and splenic vein (all p < 0.01). in the cirrhotic group, there was a significantly higher incidence of a flat flow pattern in the right anterior portal branch and a phasic flow pattern in the splenic vein than in the healthy group (both p < 0.01). among cirrhotic patients, the evb(+) group had a significantly greater mean flow volume in the splenic vein (p < 0.01), greater mean sv/pt (p < 0.01), greater mean spleen size (p < 0.05), and lower mean portal trunk n value (p < 0.05) compared with the evb(-) group. logistic regression analysis revealed that the sv/pt and portal trunk n value were independent evb-related factors.
Conclusions:
The results suggest that portal hemodynamics in cirrhotic patients are characterized by passive congestion and increased blood flow. however, these 2 features had different preponderances in different parts of the portal venous system. increased flow in the splenic vein may be the primary source of increased portal flow and may play a role in the development of evb. the sv/pt and portal trunk n value may be valuable factors for predicting evb.