Change in the hemodynamics of the portal venous system after retrograde transvenous balloon occlusion of a gastrorenal shunt.

Abstract

The purpose of our investigation was to examine changes in the hemodynamics of the liver after artificial occlusion of a gastrorenal shunt. Nine patients with portal hypertension underwent splenic arteriography and CT arterial portography during infusion of contrast material via the splenic artery. Images were obtained with the balloon catheter both inflated and deflated in the gastrorenal shunt, and results were compared. During the portal phase of splenic arteriography, the intrahepatic portal vein was more clearly seen when the balloon occluded the gastrorenal shunt. Mean CT attenuation values of branches of the intrahepatic portal vein on CT arterial portograms acquired when the balloon catheter was inflated were higher than values acquired when the balloon was deflated; however, results for the inferior vena cava were the opposite. Differences in CT attenuation values were statistically significant for the right branch of the portal vein, main portal vein, right lobe of the liver parenchyma, and inferior vena cava. Closure of large gastrorenal shunts (hepatofugal portasystemic shunts) causes the portal blood flow to switch from hepatofugal to hepatopetal, which increases the effective intrahepatic portal blood flow.