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. 1976 Sep;184(3):289–302. doi: 10.1097/00000658-197609000-00006

Hepatic artery flow improvement after portacaval shunt: a single hemodynamic clinical correlate.

A R Burchell, A H Moreno, W F Panke, T F Nealon Jr
PMCID: PMC1344383  PMID: 962397

Abstract

We have documented a highly significant increment in hepatic arterial flow following a portacaval shunt in patients with cirrhosis of the liver and portal hypertension. In contrast with other hemodynamic variables, the increment in arterial flow was directly related to morbidity, hospital mortality, and long term survival. Patients with increments smaller than 100 ml/min had the worst clinical results. They accounted for all of the hospital mortality, the largest incidence of encephalopathy, and the worst long term cumulative survival rates. The extent of the increment was not related directly to the type of shunt but, rather, to some intrinsic capability of the cirrhotic liver to increase its arterial flow in response to the relief of sinusoidal hypertension produced by the shunt. This capablilty appears related to the degree of entrapment of the hepatic arterioles by the fibrous tissues of cirrhosis. This encasement of arterioles should change the elastic properties of the hepatic arterial bed and we propose to measure these properties by determining the characteristic input impedance of the arterial bed.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson R. P., Bonchek L. I., Grunkemeier G. L., Lambert L. E., Starr A. The analysis and presentation of surgical results by actuarial methods. J Surg Res. 1974 Mar;16(3):224–230. doi: 10.1016/0022-4804(74)90035-3. [DOI] [PubMed] [Google Scholar]
  2. BERGEL D. H., MILNOR W. R. PULMONARY VASCULAR IMPEDANCE IN THE DOG. Circ Res. 1965 May;16:401–415. doi: 10.1161/01.res.16.5.401. [DOI] [PubMed] [Google Scholar]
  3. BERKSON J., GAGE R. P. Calculation of survival rates for cancer. Proc Staff Meet Mayo Clin. 1950 May 24;25(11):270–286. [PubMed] [Google Scholar]
  4. Burchell A. R., Moreno A. H., Panke W. F., Nealon T. F., Jr Hemodynamic variables and prognosis following portacaval shunts. Surg Gynecol Obstet. 1974 Mar;138(3):359–369. [PubMed] [Google Scholar]
  5. Burchell A. R., Rousselot L. M., Panke W. F. A seven-year experience with side-to-side portacaval shunt for cirrhotic ascites. Ann Surg. 1968 Oct;168(4):655–670. doi: 10.1097/00000658-196810000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. CARO C. G., McDONALD D. A. The relation of pulsatile pressure and flow in the pulmonary vascular bed. J Physiol. 1961 Aug;157:426–453. doi: 10.1113/jphysiol.1961.sp006734. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Charters A. C., 3rd, Chandler J. G., Condon J. K., Grambort D. E., Levin S. E., Modafferi T. R., Orloff M. J. Spontaneous reversal of portal flow in patients with bleeding varices treated by emergency portacaval shunt. Am J Surg. 1974 Jan;127(1):25–29. doi: 10.1016/0002-9610(74)90006-3. [DOI] [PubMed] [Google Scholar]
  8. DUMONT A. E., MULHOLLAND J. H. Flow rate and composition of thoracic-duct lymph in patients with cirrhosis. N Engl J Med. 1960 Sep 8;263:471–474. doi: 10.1056/NEJM196009082631001. [DOI] [PubMed] [Google Scholar]
  9. Dumont A. E., Mulholland J. H. Alterations in Thoracic Duct Lymph Flow in Hepatic Cirrhosis: Significance in Portal Hypertension. Ann Surg. 1962 Oct;156(4):668–675. doi: 10.1097/00000658-196210000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Elkins R. C., Peyton M. D., Greenfield L. J. Pulmonary vascular impedance in chronic pulmonary hypertension. Surgery. 1974 Jul;76(1):57–64. [PubMed] [Google Scholar]
  11. FERGUSON D. J. HEMODYNAMICS IN SURGERY FOR PORTAL HYPERTENSION. Ann Surg. 1963 Sep;158:383–386. doi: 10.1097/00000658-196309000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. GROTTE G. Passage of dextran molecules across the blood-lymph barrier. Acta Chir Scand Suppl. 1956;211:1–84. [PubMed] [Google Scholar]
  13. Kessler R. E., Tice D. A., Zimmon D. S. Hemodynamic factors reflect prognosis after portal caval shunt. Surg Forum. 1972;23(0):334–336. [PubMed] [Google Scholar]
  14. McDermott W. V., Jr Evaluation of the hemodynamics of portal hypertension in the selection of patients for shunt surgery. Ann Surg. 1972 Oct;176(4):449–456. doi: 10.1097/00000658-197210000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Milnor W. R. Arterial impedance as ventricular afterload. Circ Res. 1975 May;36(5):565–570. doi: 10.1161/01.res.36.5.565. [DOI] [PubMed] [Google Scholar]
  16. Milnor W. R., Conti C. R., Lewis K. B., O'Rourke M. F. Pulmonary arterial pulse wave velocity and impedance in man. Circ Res. 1969 Dec;25(6):637–649. doi: 10.1161/01.res.25.6.637. [DOI] [PubMed] [Google Scholar]
  17. Milnor W. R., Nichols W. W. A new method of measuring propagation coefficients and characteristic impedance in blood vessels. Circ Res. 1975 May;36(5):631–639. doi: 10.1161/01.res.36.5.631. [DOI] [PubMed] [Google Scholar]
  18. Milnor W. R. Pulsatile blood flow. N Engl J Med. 1972 Jul 6;287(1):27–34. doi: 10.1056/NEJM197207062870108. [DOI] [PubMed] [Google Scholar]
  19. Moreno A. H., Burchell A. R., Reddy R. V., Panke W. F., Nealon T. F., Jr The hemodynamics of portal hypertension revisited: determinants and significance of occluded portal pressures. Surgery. 1975 Feb;77(2):167–179. [PubMed] [Google Scholar]
  20. Moreno A. H., Burchell A. R., Reddy R. V., Steen J. A., Panke W. F., Nealson T. F., Jr Spontaneous reversal of portal blood flow: the case for and against its occurrence in patients with cirrhosis of the liver. Ann Surg. 1975 Mar;181(3):346–358. doi: 10.1097/00000658-197503000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Moreno A. H., Burchell A. R., Rousselot L. M., Panke W. F., Slafsky F., Burke J. H. Portal blood flow in cirrhosis of the liver. J Clin Invest. 1967 Mar;46(3):436–445. doi: 10.1172/JCI105545. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. PAPPENHEIMER J. R., SOTO-RIVERA A. Effective osmotic pressure of the plasma proteins and other quantities associated with the capillary circulation in the hindlimbs of cats and dogs. Am J Physiol. 1948 Mar 1;152(3):471–491. doi: 10.1152/ajplegacy.1948.152.3.471. [DOI] [PubMed] [Google Scholar]
  24. Panke W. F., Rousselot L. M., Burcheli A. R. A sixteen-year experience with end-to-side portacaval shunt for varical hemorrhage: analysis of data and comparison with other types of portasystemic anastomoses. Ann Surg. 1968 Dec;168(6):957–965. doi: 10.1097/00000658-196812000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Price J. B., Jr, Voorhees A. B., Jr, Britton R. C. Operative hemodynamic studies in portal hypertension. Significance and limitations. Arch Surg. 1967 Nov;95(5):843–852. doi: 10.1001/archsurg.1967.01330170151019. [DOI] [PubMed] [Google Scholar]
  26. Reynolds T. B. Editorial: Promises. Promises. Hemodynamics and portal-systemic shunt. N Engl J Med. 1974 Jun 27;290(26):1484–1485. doi: 10.1056/NEJM197406272902611. [DOI] [PubMed] [Google Scholar]
  27. Reynolds T. B. The role of hemodynamic measurements in portosystemic shunt surgery. Arch Surg. 1974 Mar;108(3):276–281. doi: 10.1001/archsurg.1974.01350270010003. [DOI] [PubMed] [Google Scholar]
  28. SCHENK W. G., Jr, McDONALD J. C., McDONALD K., DRAPANAS T. Direct measurement of hepatic blood flow in surgical patients: with related observations on hepatic flow dynamics in experimental animals. Ann Surg. 1962 Sep;156:463–471. doi: 10.1097/00000658-196209000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Taylor M. G. The input impedance of an assembly of randomly branching elastic tubes. Biophys J. 1966 Jan;6(1):29–51. doi: 10.1016/S0006-3495(66)86638-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. WARREN W. D., MULLER W. H., Jr A clarification of some hemodynamic changes in cirrhosis and their surgical significance. Ann Surg. 1959 Sep;150:413–427. doi: 10.1097/00000658-195909000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. WELCH C. S., WELCH H. F., CARTER J. H. The treatment of ascites by side to side portacaval shunt. Ann Surg. 1959 Sep;150:428–444. doi: 10.1097/00000658-195909000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Warren W. D., Fomon J. J., Viamonte M., Zeppa R. Preoperative assessment of portal hypertension. Ann Surg. 1967 Jun;165(6):999–1012. doi: 10.1097/00000658-196706000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Warren W. D., Zeppa R., Fomon J. J. Selective trans-splenic decompression of gastroesophageal varices by distal splenorenal shunt. Ann Surg. 1967 Sep;166(3):437–455. doi: 10.1097/00000658-196709000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]

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