Portal Vein Research Articles (Page 1)

Current hepatic inflow occlusion techniques have limitations in effectively preventing posthepatectomy liver failure (PHLF) from ischemia-reperfusion injury. Innovations in occlusion methods remain a critical area for advancement. This study investigated a hepatic inflow occlusion approach using selective portal vein occlusion (SPO) while maintaining hepatic arterial flow, aiming to evaluate its perioperative effects. Clinical data from consecutive patients who underwent hepatectomy between 2014 and 2024 were retrospectively collected. Postoperative outcomes were compared after a 1:1 ratio using propensity score matching (PSM) based on sex, age, body mass index, and Child-Pugh score using a fixed random seed. Univariate and multivariate logistic regression analyses were performed to identify risk factors for PHLF. Subgroup analyses were conducted to investigate the association between vascular occlusion strategies and the incidence of PHLF. A total of 574 patients (192 SPO and 382 Pringle) were included. After PSM, 384 patients (192 SPO and 192 Pringle) were compared. PHLF was observed in 26 patients (6.8%). Hepatectomy with SPO was associated with a lower incidence of PHLF (3.1% vs. 10.4%, P =0.026). No statistically significant difference was found in postoperative Clavien-Dindo grade III-IV complication rates between the two occlusion groups (7.3% vs. 13.0%, P =0.165). The optimal cut-off value of ICG-R15 for predicting PHLF was identified as 6.9% based on receiver operating characteristic (ROC) analysis, with an area under the curve (AUC) of 0.830 (95% CI: 0.735-0.922), a sensitivity of 88.5%, and a specificity of 66.5%. In multivariate logistic regression analysis, blood loss ( P =0.019), ICG-R15>0.069 ( P < 0.001), and undergoing >hemihepatectomy ( P < 0.001) were identified as independent risk factors for PHLF. SPO was found to be an independent protective factor ( P =0.005). Subgroup analysis identified populations that benefit more from SPO, showing a significantly lower incidence of PHLF in patients aged <60years (OR=5.42, P =0.019), males (OR=5.06, P =0.010), those with BMI ≥ 23 (OR=3.81, P =0.049), without cirrhosis (OR=4.9, P =0.003), with benign disease (OR=5.07, P =0.031), and undergoing ≤ hemihepatectomy (OR=5.16, P =0.005). The occlusion approach of SPO while preserving hepatic arterial flow can significantly reduce the incidence of PHLF.

Transarterial chemoembolization (TACE) is an effective treatment for patients with unresectable intrahepatic cholangiocarcinoma (iCCA), but tumor heterogeneity affects the efficacy of treatment. This study aimed to construct a Clinical-Radiomics (CR) model for predicting tumor response after the first TACE in patients with unresectable iCCA. A total of 107 unresectable iCCA patients who received TACE as the first treatment with available contrast-enhanced MRI (CEMRI) were retrospectively enrolled. Patients were randomly assigned to the training (N=75) and validation cohorts (N=32) in a 7:3 ratio. Radiomics features were extracted from CEMRI (arterial, portal venous, and delayed phases) for tumor, peritumor 5mm, and peritumor 10mm, respectively, and then the features were selected by random forest before constructing the radiomics model. Radiomics model score and clinical variables were analyzed using univariate and multivariate logistic regression to construct the CR model. Kaplan-Meier method was utilized to assess OS. The radiomics model constructed based on the tumor plus peritumor 10mm demonstrated the best performance. The CR model developed by combining with CA19.9 showed excellent performance in both the training (AUC = 0.941) and the validation cohorts (AUC = 0.903). Dividing groups based on the model predicted tumor responses, the Kaplan-Meier curves demonstrated a significant difference in OS between the two groups (P<0.011). The main limitations of this study include the use of a single-center cohort, which lacks external validation, and the inherent characteristics of a retrospective design, leading to an unavoidable selection bias. The model in this study demonstrated excellent performance in predicting tumor response after first TACE in patients with unresectable iCCA. The model could support clinicians to make more scientific guidance on the treatment of patients.

Paraganglioma (PGL) is a general term for tumors that originate in the paraganglia in dogs, most commonly reported in the carotid and aortic bodies. Reports on surgical treatment are rare because these tumors develop near large blood vessels, and their prognosis remains unclear. In dogs, the indications for and safety of surgical procedures involving the celiac artery (CA) root and the dissection of its major branches have not been established. To the best of our knowledge, this is the first reported case of CA root involvement in canine PGL. Surgery was performed on day 84 to remove a PGL tumor. The mass was firmly attached to the left lobe of the pancreas, portal vein, CA, and cranial mesenteric artery (CMA). Therefore, a combined resection was performed, including the spleen, left lobe of the pancreas, and left hepatic lymph nodes. Among the main branches of the CA, the splenic and left gastric arteries could not be separated and were transected. Consequently, the stomach wall became ischemic, and reduced pulsation of the left gastric and omental arteries was observed. To maintain blood supply, the common hepatic artery was preserved. After normalization of the stomach wall color, the CMA was separated from the mass, and the tumor was removed. Pathological examination confirmed that the mass was a PGL, with no metastasis to the hepatic lymph nodes. A computed tomography scan on day 265 revealed that blood flow in the common hepatic artery, portal vein, and left gastric region was well maintained. As of day 279, there was no evidence of metastasis or recurrence, and the patient remained in good condition. In this case, the main branches of the CA, except for the common hepatic artery, were transected to remove the mass; however, the patient was discharged without serious complications. This is attributable to recovery of blood flow from collateral routes. Considering this blood flow recovery and that intraoperative gastric ischemia was temporary, complete ligation of the CA root may be acceptable in some cases. Additionally, the prognosis for PGL was favorable when complete resection was achieved.

Portal hypertension (PHT) results from increased intrahepatic vascular resistance and augmented portal venous blood flow. Although cirrhosis remains the predominant etiology of PHT, non-cirrhotic PHT also requires clinical attention. This article reports a rare case of PHT with portal vein thrombosis and gastroesophageal varices secondary to essential thrombocythemia (ET). An 82-year-old female patient was admitted due to "hematemesis and melena," abdominal computed tomography revealed ascites, altered liver morphology, mild splenomegaly and PHT. The patient was admitted with a diagnosis of "decompensated cirrhosis." She maintained normal liver function over a 6-month follow-up, subsequently, the condition progressed to portal vein thrombosis, leading to gastrointestinal bleeding. Laboratory assessments at this stage revealed normal levels of albumin, liver enzymes, bilirubin, and coagulation factors, with no ascites formation, inconsistent with decompensated cirrhosis. ET was diagnosed based on Bone Marrow Aspiration and Biopsy, the JAK2 mutation was identified with a variant allele frequency of 42.2%. PHT and thrombosis in this case were attributed to ET. The patient was treated with hydroxyurea and ruxolitinib, endoscopic injection cyanoacrylate/sclerotherapy and endoscopic variceal ligation were performed. Post-discharge, oral antitumor agents and aspirin for antiplatelet therapy were prescribed, with outpatient follow-up. ET can also lead to PHT, portal vein thrombosis, and esophageal varices. Clinicians should consider these possibilities when dealing with such patients.

Optimizing future liver remnant (FLR) volumes is crucial for safe major liver resections; liver venous deprivation (LVD) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) variants (vALPPS) are widely used techniques to address this issue, but direct comparisons are limited. The study aimed to evaluate their perioperative and oncological outcomes. This was a retrospective cohort study on consecutive patients undergoing liver hypertrophy between January 2015 and July 2024 conducted at two referral centers. A total of 84 patients, according to exclusion criteria, completed the procedure (drop-out rate: 21.1%)-28 tourniquet-ALPPS (T-ALPPS), 22 hybrid-ALPPS (H-ALPPS) and 34 LVD. Clinical, surgical, and oncological variables were analyzed on the overall and colorectal liver metastases (CRLM) populations. T-ALPPS group included more CRLM (92.9% vs 50% vs 38.2%, p < 0.001) and achieved faster hypertrophy (28.5 vs 37 vs 47.5 days, p = 0.004), although pre- and post-hypertrophy techniques volumes were comparable (pre-sFLR ~28%; post-SFLR ~40%). Minimally invasive approach predominated in the LVD group (67.6% vs 27.3% vs 3.6%, p < 0.001) but implied longer operative times (426 vs 242 vs 180 min, p < 0.001). No significant differences in major complications (CD ≥ 3A), 90-day mortality, non-radical resections rates, DFS, and OS were found. In CRLM subgroup, T-ALPPS achieved higher and faster hypertrophy, while LVD presented fewer major complications rate and no 90-day mortality. Very early recurrence rate (< 6 months) was higher in the LVD group, but DFS and OS were comparable. vALPPS and LVD represent valid hypertrophy techniques, the first enabling faster regeneration and the latter allowing for more minimally invasive approaches. The choice of approach should be individualized on the basis of tumor biology, patient condition, and institutional expertise.

Abstract Background Ruptured hepatocellular carcinoma (r-HCC) is a life-threatening complication requiring urgent hemostasis. Transarterial embolization (TAE) is the first-line treatment, but the optimal embolic agent remains debated. This study reports on the use of a low-viscosity EVOH copolymer (Squid Peri12) in the emergency management of r-HCC. Methods Four patients presenting with r-HCC underwent emergency TAE using Squid Peri12. Diagnosis of rupture was based on clinical symptoms and characteristic imaging findings, including hemoperitoneum. TAE was performed via superselective catheterization using a DMSO-compatible microcatheter, with slow injection under fluoroscopic guidance. Tumor response was assessed using modified RECIST and volumetric analysis at 1, 3, and 6 months. Results Technical success was achieved in all cases, with immediate bleeding control and no procedure-related complications. Portal vein patency was preserved, and all patients were discharged within 3–5 days. At follow-up, all patients showed sustained devascularization and tumor shrinkage, with an average volume reduction exceeding 60% at 6 months. Two patients became eligible for curative-intent surgery after marked radiologic and biologic response, including one with AFP decline from 3500 to 27 ng/mL. A third declined surgery despite downstaging, and one demonstrated complete radiologic response without additional treatment. Conclusion TAE with low-viscosity EVOH was safe and effective in the acute setting of r-HCC, achieving rapid hemostasis and consistent tumor regression. These findings support further prospective evaluation of non-adhesive liquid embolics beyond emergent indications, including their potential oncologic role in unresectable HCC. Level of Evidence Level 4, Case Series.

Acute portal vein thrombosis (APVT) is a rare condition characterized by recent thrombus formation within the main portal vein or its branches. APVT occurring in patients without underlying cirrhosis or malignancy represents an even rarer presentation, with an estimated prevalence of 0.7–3.7 per 100,000 individuals. However, it can lead to severe complications, including intestinal infarction and mortality. We report two cases presenting with abdominal pain without an apparent precipitating factor. Both patients were diagnosed with APVT based on contrast-enhanced computed tomography (CT) findings, clinical presentation, and laboratory parameters. Depending on the extent of portal vein occlusion, distinct therapeutic approaches were employed: one patient underwent interventional therapy combining transjugular mechanical thrombectomy/thrombolysis with transjugular intrahepatic portosystemic shunt (TIPS) placement, while the other received systemic pharmacological thrombolysis. Successful portal vein recanalization was achieved in both patients, who subsequently recovered and were discharged. These cases underscore that prompt diagnosis and management of APVT can avert adverse clinical outcomes. Contrast-enhanced CT demonstrates significant value in classifying APVT, assessing disease severity, evaluating treatment response, and identifying complications, thereby providing crucial evidence for clinical decision-making.

Background: AF is a common comorbidity in patients with liver cirrhosis and may negatively impact both quality of life and prognosis. The management of AF in this population is complex due to cirrhosis-related disruptions in hemostasis, which increase the risk of both thrombosis and bleeding. These competing risks make decisions regarding anticoagulation therapy particularly challenging. This study aimed to evaluate the impact of anticoagulation on outcomes among patients with cirrhosis and coexisting AF. Research Question: Does anticoagulation use affect mortality, complications, or resource utilization in hospitalized patients with liver cirrhosis and atrial fibrillation? Methods: We conducted a retrospective cohort study using data from the National Inpatient Sample (NIS) from 2016 to 2021. Adult patients hospitalized with liver cirrhosis were identified using ICD-10 diagnostic codes. Among these, individuals with coexisting AF were selected and categorized by current or long-term use of anticoagulation (AC). The primary outcome was in-hospital mortality. Secondary outcomes included length of stay (LOS), total hospital charges (THC), ICU utilization, mesenteric ischemia, portal vein thrombosis, venous thromboembolism (deep vein thrombosis [DVT] and pulmonary embolism [PE]), acute myocardial infarction/angina (AMI), cardiac arrest, and bleeding complications (transfusion, gastrointestinal bleeding, intracranial hemorrhage). Multivariable regression analyses were performed adjusting for patient demographics, comorbidities, and hospital characteristics. Results: The study included 11,140 patients with cirrhosis and AF, of whom 2,417 (21.70%) received AC. AC use was associated with reduced in-hospital mortality (adjusted odds ratio [aOR] 0.75; 95% CI, 0.58–0.98; P=0.03), ICU admission (aOR 0.65; 95% CI, 0.50–0.84; P&lt;0.01), AMI (aOR 0.71; 95% CI, 0.54–0.95; P=0.02), and GI bleeding (aOR 0.75; 95% CI, 0.62–0.90; P&lt;0.01). No significant differences were found in LOS, THC, mesenteric ischemia, portal vein thrombosis, DVT/PE, cardiac arrest, transfusion, or intracranial hemorrhage. Conclusion: In hospitalized patients with cirrhosis and AF, AC therapy was associated with reduced mortality, ICU use, AMI, and GI bleeding, without increased risk of other major complications. These findings support the safety and benefit of AC in this population and underscore the need for individualized risk assessment rather than default avoidance due to cirrhosis

Purpose This study aims to provide insights into the rare occurrence of cerebral lipiodol embolism following transcatheter arterial chemoembolization (TACE) in treating hepatocellular carcinoma (HCC). By analyzing a specific case, this research seeks to enhance clinical understanding of the pathogenesis, manifestations, and management strategies for this complication, ultimately improving patient outcomes. Background Cerebral lipiodol embolism is an infrequent yet severe complication of TACE, a standard treatment for unresectable HCC. The embolism occurs when iodized oil, used during the procedure, inadvertently enters the cerebral circulation, often due to arteriovenous shunts associated with liver tumors. Despite TACE’s widespread use, awareness and understanding of this rare complication remain limited, necessitating further investigation to mitigate risks and improve patient safety. Case presentation A 64-year-old man with multiple HCCs and portal vein invasion underwent TACE involving iodized oil and chemotherapy agents. Post-procedure, the patient exhibited neurological deficits, including decreased consciousness and right-sided weakness. Imaging confirmed cerebral lipiodol embolism. Despite gradual neurological improvement, the patient continued to experience significant right-sided weakness, highlighting the long-term impact of this complication. Conclusion Cerebral lipiodol embolism, though rare, poses significant risks during TACE. Early detection through careful imaging and precautionary measures, such as managing Lipiodol injection volumes and speeds, is crucial. Enhanced clinical awareness and intervention strategies can prevent lipiodol from entering the systemic circulation, reducing the incidence of this severe complication.

A BSTRACT Background: Percutaneous core needle biopsy (CNB) is used to diagnose biliary atresia (BA), while subcapsular wedge biopsy (WB) is a routine part of Kasai portoenterostomy (KPE). This study compares the histopathological features of CNB and WB, evaluates the necessity of CNB during KPE, and explores whether WB can be omitted if CNB has already been performed. Materials and Methods: A retrospective study was conducted at a tertiary care institute involving BA patients who underwent preoperative CNB and intraoperative WB from 2018 to 2023, analyzing and comparing histopathological parameters. Results: A total of 14 patients were included, all showing liver fibrosis on both CNB and WB. Portal inflammation (PI) and stromal edema (SE) were present in all on CNB. Ductular reaction (DR), ductular cholestasis, and lobular cholestasis (LC) were found in all but one patient. WB revealed a higher incidence of ductal plate malformation (DPM) and greater severity of fibrosis, DR, PI, and LC. In contrast, CNB showed a higher incidence of portal vein abortive (PVA) and more cellular death (CD). Conclusion: Specific histological parameters were more evident in CNB (PVA and CD), while others were more prominent in WB (fibrosis, DR, DPM, PI, and LC). Although CNB has a definitive diagnostic role preoperatively, it can be avoided along with intraoperative WB. In contrast, WB should be a routine part of KPE, regardless of preoperative CNB status.

The preoperative estimation of the volumetric and especially functional future liver remnant (FLR) is of particular importance before major liver resections to avoid posthepatectomy liver failure (PHLF). A postoperative regeneration of the liver is only possible if there is sufficient functional FLR. Laboratory parameter scores, such as the combined aspartate aminotransferase to platelet ratio index (APRI)/albumin-bilirubin grade (ALBI) score, can provide an initial assessment of the risk of PHLF. Other functional tests, such as the ICG-R15 test, the LiMAx® (Humedics GmbH, Berlin, Germany) test or scintigraphic procedures (e.g. technetium 99m mebrofenin secretion) can be used in the event of abnormal findings in order to assess liver function more precisely. In the case of inhomogeneous parenchymal quality, for example after portal vein embolization (PVE), knowledge of the segmental functional distribution is essential. This can be done by functional imaging techniques, such as the technetium 99m mebrofenin scintigraphy examinations in combination with magnetic resonance imaging (MRI). Although not yet approved for functional testing, MRI with the hepatocyte-specific contrast agent gadolinium provides apracticable surrogate parameter for parallel three-dimensional (tumor) imaging. This procedure is already well validated. In the future, deep learning algorithms will enable automated analyses of segmental liver function; however, surgical expertise remains decisive for assessing resectability. As aguideline the rule of thumb is at least 30% parenchymal reserve in patients with a healthy liver and 40% in risk constellations. This article provides an overview of current concepts and diagnostic procedures for the preoperative assessment of sufficient parenchymal reserve.

Abstract Background Metabolic dysfunction-associated hepatic steatosis, the most common chronic liver disease worldwide, poses a growing public health challenge due to its high global incidence and risk of progression to cirrhosis. The purpose of this study was to evaluate, using Doppler ultrasound, hemodynamic changes in the hepatic artery and the portal vein in patients with hepatic steatosis. Materials and methods This was a case–control study with prospective data collection conducted at the Sokodé Regional Hospital Centre (Togo) between August 2023 and March 2024. The study consecutively included 60 patients with ultrasound signs of diffuse liver steatosis and 60 healthy volunteers with normal liver parenchymal echotexture and echogenicity. Results The maximum systolic velocity of the hepatic artery was significantly higher in patients than in controls (41.72 ± 8.79 cm/s vs. 35.94 ± 7.56 cm/s; p &lt; 0.01). The resistance index (RI) of the hepatic artery was significantly higher in controls than in patients (0.76 ± 0.11 vs. 0.72 ± 0.04; p &lt; 0.01). The maximum portal vein systolic velocity was 17.50 ± 3.55 cm/s in patients and 19.58 ± 2.17 cm/s in controls ( p &lt; 0.001), while the maximum time average velocity (TAMV) was 13.23 ± 2.52 cm/s and 15.39 ± 2.61 cm/s, respectively ( p &lt; 0.01). These variations in the Doppler index of the hepatic artery and the portal vein were correlated with the grade of liver steatosis. Conclusions Doppler ultrasound evaluation of hepatic vessels may serve as a valuable tool to detect early signs of hepatic hemodynamic dysfunction and could help to detect hepatic steatosis.

Meta-analysis of LVD versus PVE in treating liver cancer with an insufficient liver remnant.

This study aimed to develop and validate a prognostic model for hepatocellular carcinoma (HCC) patients undergoing liver resection, using the functional liver imaging score (FLIS) derived from hepatobiliary-specific contrast-enhanced magnetic resonance imaging (MRI). A total of 694 pathologically confirmed HCC patients who underwent hepatobiliary-specific MRI with either gadoxetic acid or gadobenate dimeglumine and subsequent liver resection were included. FLIS was calculated by assigning 0-2 points to three hepatobiliary-phase MRI features: hepatic enhancement, biliary excretion, and portal vein signal intensity. Multivariable Cox regression identified AFP level, tumor size, and extent of resection as independent predictors of overall survival (OS). FLIS ≤ 2, alpha-fetoprotein (AFP) > 400ng/mL, tumor size > 5cm, and major resection were identified as independent predictors of worse OS. A predictive model combining these factors demonstrated excellent prognostic performance, with Harrell's concordance indices of 0.91 in the training cohort and 0.96 internal validation cohort, and 0.94 in external validation cohort. The FLIS-based model significantly outperformed FLIS alone and conventional clinical models (p < 0.05). Kaplan-Meier survival analysis showed that low-risk patients had significantly better OS and recurrence-free survival (RFS) compared to high-risk patients across all cohorts (p < 0.05). FLIS is a simple, non-invasive imaging biomarker for evaluating liver function and predicting outcomes in HCC patients. When integrated with key clinical variables, the FLIS-based model demonstrates excellent discrimination and calibration for OS and RFS, providing accurate postoperative prognostic stratification and showing great potential for guiding surveillance and improving long-term survival outcomes in future clinical applications.

Heparanase and MMP-9 synergistically induce endothelial-mesenchymal transition in portal vein microvessels to promote hepatocellular carcinoma metastasis.

Management and outcomes for portal venous thrombosis after pancreaticoduodenectomy.

Living Donor Liver Transplantation in Patients With Portal Vein Thrombosis: A Single-Center Experience.

Double vein embolization before major hepatectomy: A single-center experience.

Coats plus syndrome (CPS) is a rare telomere biology disorder (TBD) linked to mutations in the CTC1-STN1-TEN1 complex and characterized by cerebroretinal microangiopathy, bone marrow failure, and liver disease, often progressing to hepatopulmonary syndrome (HPS). The case is a 16-year-old boy clinically diagnosed with CPS at age 7. He developed exertional dyspnea at 14 with 93% of resting oxygen saturation (SpO2), 70 mmHg of partial pressure of oxygen (PaO2), and 22.9 mmHg of alveolar-arterial oxygen difference (A-aDO2) under room air, prompting home oxygen therapy (HOT). Imaging and liver biopsy showed significant collateral circulation and portal vein fibrosis and dilation without cirrhosis or pulmonary fibrosis. HPS was diagnosed by positive microbubble contrast echocardiography and 15.7% of shunt fraction in pulmonary ventilation-perfusion scintigraphy. Due to the rapid progression of HPS, he underwent living-donor LT. The postoperative disease course was good, except for acute liver rejection, and the patient was discharged on postoperative day 40. One month after transplantation, echocardiography showed a negative bubble study, pulmonary scintigraphy revealed an improved shunt fraction of 10.2%, resting SpO2 under room air was 100%, and he is doing well without the recurrence of HPS. Historically, LT for HPS patients with TBDs was avoided because of uncertain prognosis and potential disease progression in other organs. However, early-stage LT in TBDs may be preferable and reduce the complexity of LT. Before irreversible changes in intrapulmonary blood vessels occur, early hypoxemia monitoring and regular imaging are essential to ensure timely LT for HPS.

Advantages of intravascular ultrasound guidance for TIPS: Systematic review of the literature and a single institution propensity score-matched study.