Surratt R S, Middleton W D, Darcy M D, Melson G L, Brink J A
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110.
AJR Am J Roentgenol. 1993 Mar;160(3):627-30. doi: 10.2214/ajr.160.3.8430568.
The purpose of this study was to describe the morphologic and hemodynamic findings in the hepatic vasculature before and immediately after creation of a transjugular intrahepatic portosystemic shunt.
We used gray-scale, duplex, and color Doppler sonography to prospectively examine 25 patients before and after percutaneous placement of a stent to create a transjugular intrahepatic portosystemic shunt. Patency and direction of flow were determined in the stent and in the main, right, and left portal veins. Flow velocity was measured in the stent and in the main portal vein.
In all patients, the stent was easily identified as connecting branches of the portal and hepatic veins. Three thrombosed stents were correctly detected sonographically. One stent that was thought to be thrombosed at sonography was found to be patent at angiography. Flow velocities in the patent stents ranged from 73 to 185 cm/sec (mean, 130 +/- 33 cm/sec). Mean peak velocities in the main portal vein were 20 cm/sec before stent placement and 38 cm/sec after stent placement (p < .002). In 14 patients, flow direction in the left or right portal vein was hepatofugal after the stent was placed. In two of these 14 patients, long-term follow-up showed subsequent conversion of flow in the portal vein branches from hepatofugal to hepatopetal. One of these two patients had a thrombosed stent and the other had a hepatic vein stenosis above the stent. The second patient also had a proven decrease in flow velocity in the stent at the time of stenosis.
We conclude that high flow velocities are expected in the main portal vein and in the stent immediately after the shunt is created and that flow in portal vein branches is usually hepatofugal. We recommend sonography soon after the shunt is created, so that baseline flow velocity in the stent and flow direction in portal vein branches can be established, because a subsequent decrease in flow velocity in the stent or a change in direction of flow in a portal branch may indicate stent malfunction.
本研究的目的是描述经颈静脉肝内门体分流术创建前及创建后即刻肝内血管系统的形态学和血流动力学表现。
我们使用灰阶、双功及彩色多普勒超声对25例患者在经皮放置支架以创建经颈静脉肝内门体分流术前后进行前瞻性检查。确定支架以及门静脉主干、右支和左支内的通畅情况和血流方向。测量支架及门静脉主干内的血流速度。
在所有患者中，支架均易于被识别为连接门静脉和肝静脉的分支。超声检查正确检测出3个血栓形成的支架。1个在超声检查时被认为血栓形成的支架在血管造影时显示通畅。通畅支架内的血流速度范围为73至185厘米/秒（平均为130±33厘米/秒）。放置支架前门静脉主干的平均峰值速度为20厘米/秒，放置支架后为38厘米/秒（p<0.002）。在14例患者中，放置支架后左或右门静脉内的血流方向为离肝血流。在这14例患者中的2例，长期随访显示门静脉分支内的血流随后从离肝血流转变为向肝血流。这2例患者中的1例有血栓形成的支架，另1例在支架上方有肝静脉狭窄。第2例患者在狭窄时支架内的血流速度也证实降低。
我们得出结论，分流创建后即刻门静脉主干和支架内预期会有高血流速度，且门静脉分支内的血流通常为离肝血流。我们建议在分流创建后不久进行超声检查，以便确定支架内的基线血流速度和门静脉分支内的血流方向，因为支架内血流速度随后降低或门静脉分支内血流方向改变可能表明支架功能异常。
