Abstract
The puropse of this study was to evaluate associations of cisterna chyli (CCh) diameter with portal hemodynamics and the influence of TIPS-creation in cirrhotic patients. 93 cirrhotic patients (57 male, mean age 59 years) received CT prior to TIPS-creation. 38/93 additionally underwent post-interventional CT. CCh-diameter was measured. After categorization into patients with and without large venous collaterals (i.e. > 6 mm), data were analyzed regarding associations between CCh-diameter, clinical and portal-hemodynamic parameters and diameter-changes after TIPS-creation. Patient survival post-TIPS was analyzed. Median portosystemic pressure-gradient decreased from 20 to 9 mmHg after TIPS-creation. Large venous collaterals were observed in 59 patients. In 69/93 patients (74.2%) the CCh was detectable. Mean pre-interventional diameter was 9.4 ± 2.7 mm (large collaterals: 8.7 ± 2.0 mm, no large collaterals: 10.7 ± 3.2 mm, p = 0.003). CCh-diameter correlated strongly with pre-TIPS portal-pressure (Rs = 0.685, p = 0.0001), moderately with portosystemic-gradient (Rs = 0.524, p = 0.006), liver shear-wave-elastography (Rs = 0.597, p = 0.004) and spleen size (Rs = 0.501, p = 0.01) in patients without large collaterals, but not in patients with large collaterals. Post-TIPS CCh-diameter decreased significantly from 10.2 ± 2.8 mm to 8.3 ± 3.0 mm (p < 0.001). Patients without a detectable CCh on CT survived significantly shorter. The diameter of the CCh is associated with portal-pressure and decreases after TIPS-creation in cirrhotic patients, reflecting a portal decompression mechanism via the lymphatic system. Lack of larger central lymphatics detectable on CT may be associated with shorter survival.
Highlights
The puropse of this study was to evaluate associations of cisterna chyli (CCh) diameter with portal hemodynamics and the influence of transjugular intrahepatic portosystemic shunt (TIPS)-creation in cirrhotic patients. 93 cirrhotic patients (57 male, mean age 59 years) received computed tomography (CT) prior to TIPS-creation. 38/93 underwent postinterventional CT
All consecutive patients suffering from liver cirrhosis with portal hypertension who underwent TIPS creation at our institution from 2014 to 2016 were retrospectively identified and screened
Pre-TIPS portal pressure was slightly, but significantly higher in patients receiving TIPS for variceal bleeding than in patients treated for ascites
Summary
The puropse of this study was to evaluate associations of cisterna chyli (CCh) diameter with portal hemodynamics and the influence of TIPS-creation in cirrhotic patients. 93 cirrhotic patients (57 male, mean age 59 years) received CT prior to TIPS-creation. 38/93 underwent postinterventional CT. The puropse of this study was to evaluate associations of cisterna chyli (CCh) diameter with portal hemodynamics and the influence of TIPS-creation in cirrhotic patients. The diameter of the CCh is associated with portal-pressure and decreases after TIPS-creation in cirrhotic patients, reflecting a portal decompression mechanism via the lymphatic system. Fluid that is filtered out of the sinusoids into the space of Disse can flow either into the interstitial space of the portal tracts, sublobular veins or the c apsule[3] From here it enters the respective lymphatic system (portal, sublobular or superficial) with primary drainage (80%) via the portal lymphatics and the hepatic trunc into the cisterna chyli. The purpose of this study was to investigate associations of cisterna chyli diameter on cross-sectional imaging with clinical and portal hemodynamic parameters, the influence of portal decompression by transjugular intrahepatic portosystemic shunt (TIPS)-creation in cirrhotic patients with portal hypertension as well as patient outcome
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