Evaluation of portal hemodynamic changes following devascularization procedure by using color doppler velocity profile

Abstract

A devascularization procedure consisting of splenectomy and pericardial devascularization is an effective treatment for esophageal variceal bleeding. To assess the influence of this procedure on portal hemodynamics, the color Doppler velocity profile (CDVP) technique was used to evaluate perioperative portal hemodynamics in 28 cirrhotic patients with portal hypertension who underwent the devascularization procedure. The results showed that postoperative portal trunk (PT) flow volume was significantly reduced by 10.1±8.0 ml/min/kg, and the reduction was closely related to preoperative splenic venous (SV) flow volume, with a correlation coefficient of r=0.65 (p<0.001). Maximum cross-sectional mean velocity (CS-Vmax) and flow volume of right anterior branch (RAB) were lowered after surgery by 2.0±2.6 cm/s and 3.2±2.9 ml/min/kg, respectively, and the reduction in flow volume was closely related to its preoperative level, with a correlation coefficient of r=0.74 (p<0.001). Portal venous pressure (PVP) after surgery was significantly lowered by 6.0±4.9 cm H2O (p<0.001), and the postoperative PVP level bore a close relationship with its preoperative level, with a correlation coefficient of r=0.66 (p<0.01). We conclude, that the CDVP technique presents a useful tool for monitoring postoperative changes in portal hemodynamics. The devascularization procedure markedly relieved portal hyperdynamics by eliminating SV inflow. As a consequence of reduction in PT flow volume and PVP, intrahepatic portal perfusion was greatly reduced after surgery, which may be unfavorable to maintenance of liver function.