Educational Exhibit Authors: M. V. Malakhova, S. Kim, M. Sorokina, T. Galyan, V. Khovrin, I. Kryukova, Y. Kamalov ; Kaluga/RU, Moscow/RU, RU, 4

Transcription

1 Criterias evaluation splenic and superior mesenteric veins by MSCT data to select the tactics of surgical treatment at patients with portal hypertension syndrome. Poster No.: C-1059 Congress: ECR 2014 Type: Educational Exhibit Authors: M. V. Malakhova, S. Kim, M. Sorokina, T. Galyan, V. Khovrin, I. Kryukova, Y. Kamalov ; Kaluga/RU, Moscow/RU, RU, 4 Moskau/RU Keywords: Abdomen, Veins / Vena cava, CT, CT-Angiography, Contrast agent-intravenous, Diagnostic procedure, Surgery, Hypertension, Embolism / Thrombosis DOI: /ecr2014/C-1059 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 19

2 Page 2 of 19

3 Learning objectives Portal hypertension is a common clinical syndrome that refers to abnormally high blood pressure in the portal vein system due to the blockage in the blood flow in the portal and hepatic veins. Symptoms include varix dilatation of subcutaneous periumbilical veins (caput Medusae), gastric, esophageal and anorectal varices, ascites, splenomegaly, liver failure, acquired porto-systemic bypasses. Amount patients with portal hypertension grows every year and their treatment still remains a serious problem [1]. In spite of numerous studies remains the problem of selection criterias for patients to perform different kinds of surgical intervention [9]. Patient with suspected portal hypertension syndrome runs a complex surveys which includes complete blood count and biochemical analysis of blood, determination of viral hepatitis markers, abdominal ultrasound, fibrogastroduodenoscopy, rectoromanoscopy. But the most accurate and reliable imaging technique in assessment of portal hypertension is multiphase MDCT. Surgical treatment of portal hypertension syndrome can be divided into 3 groups: 1. Palliative: endoscopic, endovascular interventions and open surgery on esophageal and gastric varices (disconnection surgery). 2. Conditionally radical: portocaval anastomosis and transjugular intrahepatic portosystemic shunt. 3. Radical: liver transplantation in patients with liver cirrhosis. The aim of our research is definition the anatomic-topografical evaluation criterias of splenic and superior mesenteric vein, influencing to the choice of surgical treatment of patients with portal hypertension syndrome. And development the optimal protocol description of the study patients with this syndrome. Page 3 of 19

4 Images for this section: Fig. 1: Portal hypertension syndrome Page 4 of 19

5 Fig. 2 Page 5 of 19

6 Fig. 3: Varix dilatation gastric vein Page 6 of 19

7 Background 130 patients were examined for portal hypertension syndrome. All studies were conducted on Aquilion One (Toshiba) and Somatom Definition Flash (Siemens) using the same scanning options (KV- 120, Mas - CareDose, slice - 0,5-1mm, collimation 128#0,5) and 4-phase scanning protocol (native phase, arterial phase (10sec), portal phase (45sec), venous phase (65sec). The volume of contrast agent (Visipaque 320, Omnipaque 350) was determined at the rate of ml per kg (max 120ml), flow was 4-4,5 ml sec. Page 7 of 19

8 Images for this section: Fig. 4: Native phase Page 8 of 19

9 Fig. 5: Arterial phase (10sec) Page 9 of 19

10 Fig. 6: Portal phase(45sec) Page 10 of 19

11 Fig. 7: Venous phase (65sec) Page 11 of 19

12 Findings and procedure details The obtained data were processed by postprocessing workstations followed 3D conversion. We evaluated diameter and permeability splenic vein (optimal diameter 10mm). Its topography in relation to pancreatic tissue because a frequent complication is the development of acute postoperative pancreatitis and the distance between the connectable vessels (splenic and left kidney vein). Also we evaluated diameter and permeability of the superior mesenteric vein and its branches (v.colica dextra, v. colica media and v. ileocolica) - optimal diameter 8-12mm, the distance between them and vein cavae inferior to select tactics of surgical treatment. Also in the protocol description of the study in patients with portal hypertension syndrome we included evaluation of diameter, permeability, topography portal vein, left gastric vein, vena cava inferior, renal veins and veins in the lower two thirds of the esophagus and stomach. In addition we paid attention to the size and assessment of the parenchyma of liver and spleen, presence / absence of spontaneous portal-systemic bypasses and presence / absence of free abdominal fluid. All surveyed were investigated. All patients underwent surgery: 19 patients spleno-renalis anastomosis, 32 patients-mesenterico-caval anastomosis. At 79 patients splenic vein was tortuous and visualized in the tissue of pancreas, with thrombosis veins of the portal system and long distance between splenic and left kidney vein. Thatswhy they was carried out the azygo-portal disconnection (gastrotomy with needling esophageal and gastric varices, supplemented with the gastric devascularization). Intraoperative picture in all cases fully coincided with the data were obtained by CT-angiography. Page 12 of 19

13 Images for this section: Fig. 8: Portal hypertension syndrome Page 13 of 19

14 Fig. 9: Spleno-renal anastomosis Page 14 of 19

15 Fig. 10: Mesenterico-caval anastomosis Page 15 of 19

16 Conclusion The developed criterias evalution splenic and superior mesenteric veins and the protocol description of the study patients with portal hypertension syndrome give the clear information about the possibility of imposing a porto-caval anastomosis in the preoperative stage that allows to increase the efficiency of operations and to reduce the number of postoperative complications. Page 16 of 19

17 Personal information Mariia Malakhova, radiology resident Department of radiodiagnosis and computer tomography, Russian Research Center for Surgery named by B.V.Petrovsky, Moscow, Russia Stanislav Kim, radiologist Department of radiodiagnosis and computer tomography, Russian Research Center for Surgery named by B.V.Petrovsky, Moscow, Russia Marina Sorokina, radiologist Department of radiodiagnosis and computer tomography, Russian Research Center for Surgery named by B.V.Petrovsky, Moscow, Russia Tatjyana Galyan, radiologist, Ph.D. Department of radiodiagnosis and computer tomography, Russian Research Center for Surgery named by B.V.Petrovsky, Moscow, Russia Valery Khovrin, radiologist, Ph.D. Department of radiodiagnosis and computer tomography, Russian Research Center for Surgery named by B.V.Petrovsky, Moscow, Russia Irina Kryukova, surgeon, Ph.D. Department of urgent surgery and portal hypertension, Russian Research Center for Surgery named by B.V.Petrovsky, Moscow, Russia Yury Kamalov, radiologist, M.D., prof. Page 17 of 19

18 Department of radiodiagnosis and computer tomography, Russian Research Center for Surgery named by B.V.Petrovsky, Moscow, Russia Page 18 of 19

19 References 1. Eramishantsev A.K. Primary e#trahepatic portal hypertension and its surgical treatment.// Diss. - Moscow, Eramishantsev A.K. Surgical treatment of portal hypertension syndrome in Russia.// Rus. jour. gastroenterol., hepatol., coloproct # Eramishantsev A.K., Lebezev V.M., Plekhanov A.N. Porto-caval shunting of patients with portal hypertension syndrome. // International symposium. Minsk, Lebezev V.M. Porto-caval shunting of patients with portal hypertension syndrome. // Diss. - Moscow, Manukjyan V.G. The choice of surgical treatment of patients with portal hypertension syndrome. // Diss. - Moscow, Manukjyan V.G. Pathogenesis, treatment and prevention of complications patients with liver cirrhosis in portal surgery. // Diss. - Moscow, Agarwal A., Jain M. Multidetector CT portal venography in evalution of portosystemic collateral vessels. // J Med Imaging Radiat Oncol Vol.52 - #1 - P Alexander Keedy, Antonio C. Westphalen, Aliya Qayyum, Rizwan Aslam, Alexander V. Rybkin, Mei-Hsiu Chen, Fergus V. Coakley. Diagnosis of cirrhosis by spiral computed tomographe: a case-control study with feature analysis and assessment of interobserver agreement. // J Comput. Assist. Tomogr Vol # Bolondi L., Zironi G., Galiati S., Li Bassi S., Benzi G., Barbara L. Caliber of splenic and hepatic arteries and spleen size in cirrhosis of different etiology. // Liver Vol # Collins J.C., Rypins E.B., Sarfeh I.J. Narrow-diameter portacaval shunts for management of variceal bleeding. // Word J Surg Vol # Page 19 of 19