Cannella Roberto, Tselikas Lambros, Douane Fréderic, Cauchy François, Rautou Pierre-Emmanuel, Duran Rafael, Ronot Maxime
Université Paris Cité; AP-HP, Hôpital Beaujon, Service de Radiologie, Clichy; Centre de Recherche sur l'inflammation Inserm, UMR 1149, Paris, France.
Section of Radiology - Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital "Paolo Giaccone", Via del Vespro 129, 90127 Palermo, Italy.
JHEP Rep. 2022 Apr 4;4(7):100484. doi: 10.1016/j.jhepr.2022.100484. eCollection 2022 Jul.
Portal hypertension is defined by an increase in the portosystemic venous gradient. In most cases, increased resistance to portal blood flow is the initial cause of elevated portal pressure. More than 90% of cases of portal hypertension are estimated to be due to advanced chronic liver disease or cirrhosis. Transjugular intrahepatic portosystemic shunts, a non-pharmacological treatment for portal hypertension, involve the placement of a stent between the portal vein and the hepatic vein or inferior vena cava which helps bypass hepatic resistance. Portal hypertension may also be a result of extrahepatic portal vein thrombosis or compression. In these cases, percutaneous portal vein recanalisation restores portal trunk patency, thus preventing portal hypertension-related complications. Any portal blood flow impairment leads to progressive parenchymal atrophy and triggers hepatic regeneration in preserved areas. This provides the rationale for using portal vein embolisation to modulate hepatic volume in preparation for extended hepatic resection. The aim of this paper is to provide a comprehensive evidence-based review of the rationale for, and outcomes associated with, the main imaging-guided interventions targeting the portal vein, as well as to discuss the main controversies around such approaches.
门静脉高压症是由门体静脉梯度增加所定义的。在大多数情况下，门静脉血流阻力增加是门静脉压力升高的初始原因。据估计，超过90%的门静脉高压症病例是由晚期慢性肝病或肝硬化引起的。经颈静脉肝内门体分流术是一种用于门静脉高压症的非药物治疗方法，涉及在门静脉与肝静脉或下腔静脉之间放置支架，以帮助绕过肝内阻力。门静脉高压症也可能是肝外门静脉血栓形成或受压的结果。在这些情况下，经皮门静脉再通可恢复门静脉主干通畅，从而预防门静脉高压症相关并发症。任何门静脉血流受损都会导致进行性实质萎缩，并触发保留区域的肝再生。这为使用门静脉栓塞术调节肝脏体积以准备进行扩大肝切除术提供了理论依据。本文的目的是对主要针对门静脉的影像引导干预措施的理论依据和相关结果进行全面的循证综述，并讨论围绕此类方法的主要争议。
