Acute Increase in Hepatic Arterial Flow During TIPS Identified by Intravascular Flow Measurements
Acute Increase in Hepatic Arterial Flow During TIPS Identified by Intravascular Flow Measurements
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DOI：
10.1007/s00270-008-9435-0
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发表时间：
2009-01-01
影响因子：
2.9
通讯作者：
Richter, Goetz Martin
中科院分区：
文献类型：
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作者：
Radeleff, Boris;Sommer, Christof-Matthias;Richter, Goetz Martin
本研究的目的是应用血管内多普勒超声研究经颈静脉肝内门体分流术(TIPS)期间肝动脉血流的变化。这项前瞻性的单中心研究包括25例成功应用TIPS治疗的患者(酒精性肝炎[19例]、慢性肝炎相关患者[3例]、原发性胆汁性肝炎相关患者[1例]和不明原因肝炎患者[2例])。所有患者均在TIPS术中使用腔内血流传感器进行血管内肝动脉血流测量。记录平均动脉峰值速度(APV)和最大动脉峰值速度(MPV)。22例(88%)术后APV升高，1例(4%)APV未受影响，2例(8%)APV下降。平均门体压力梯度显著降低，从TIPS前的22.0+/-A5.1毫米汞柱降至TIPS后的11.0+/-A4.1毫米汞柱(-50.0%；p<；0.0001)。平均平均肺活量由治疗前的41.9+/-A17.8 cm/S增加到治疗后的60.7+/-19.0 cm/S(+44.9%；P<0.0001)。平均平均MPV由治疗前的90.8+/-A31.7 cm/S增加到治疗后的112.6+/-A34.9 cm/S(+24.0%；p=0.0002)。在所有APV升高的患者中，这些血流灌注的变化在TIPS途径形成后的几秒钟内开始出现。我们的结论是，TIPS诱导的门体减压导致肝动脉血流量显著增加。这些变化发生在几秒钟内，表明这是一种类似反射的机制。
The purpose of this study was to investigate alterations of hepatic arterial flow during transjugular intrahepatic portosystemic stent shunt (TIPS) applying intravascular Doppler sonography. This prospective monocenter study included 25 patients with liver cirrhosis (alcohol induced [n = 19], chronic hepatitis associated [n = 3], primary biliary cirrhosis associated [n = 1], and cryptogenic [n = 2]) successfully treated with TIPS. All patients underwent intravascular hepatic arterial flow measurements during TIPS using an endoluminal flow sensor. The average arterial peak velocity (APV) and the maximum arterial peak velocity (MPV) were registered. Twenty-two patients (88%) showed increased APV, one patient (4%) showed unaffected APV, and two patients (8%) showed decreased APV after TIPS. The average portosystemic pressure gradient decreased significantly, from 22.0 +/- A 5.1 mmHg before TIPS to 11.0 +/- A 4.1 mmHg after TIPS (-50.0%; p < 0.0001). The average APV increased significantly, from 41.9 +/- A 17.8 cm/s before TIPS to 60.7 +/- A 19.0 cm/s after TIPS (+44.9%; p < 0.0001). The average MPV increased significantly, from 90.8 +/- A 31.7 cm/s before TIPS to 112.6 +/- A 34.9 cm/s after TIPS (+24.0%; p = 0.0002). These changes in perfusion set in within seconds after TIPS tract formation in all the patients with increased APV. We conclude that TIPS-induced portosystemic decompression leads to a significant increase in hepatic arterial flow. The changes occurred within seconds, suggesting a reflex-like mechanism.