Angiographic Study of Hemodynamics in Portal Hypertension with Cirrhosis and Evaluation of Esophageal Transection

Ryo Nakanishi

Second Department of Surgery, Juntendo University, School of Medicine

We studied portal hemodynamics in 222 cases of liver cirrhosis with esophageal varices, using angiography. We also studied the effects of esophageal transectioh from the hemodynamic aspect. The cases were classified into 4 groups (Hepatofugal G., Hepatopetal G., Alternate G., Unknown G.) according to the blood flow direction of the left gastric vein, obtained by arterial portography. The degrees of esophageal varices were more severe and hepatic function poorer in the hepatofugal and alternate group than in the hepatopetal group. In the hepatofugal group, the left gastric artery was found to be narrow while the left gastric vein was enlarged. In liver cirrhosis, as hepatic dysfunction progresses, the blood flow in the left gastric vein may change from being hepatopetal in direction to the hepatofugal or alternate direction, and the esophageal varices may develop. The contribution of portal blood was considered to possibly be larger than that of gastric arterial blood as an aggravation factor of esophageal varices. Remaining esophageal varices after esophageal transection were observed in 8.9% of cases in the hepatofugal group. In other groups, there were no remaining varices. According to postoperative angiography, 90% of the effective cases in the hepatofugal group showed patent paraesophageal veins or gastro-renal shunt or hepatopetal flow in the left gastric vein. This was considered to be important for reserving collateral veins, other than varices, to prevent recurrence postoperatively.

Key words
hemodynamics of portal hypertension, esophageal varices, left gastric vein, liver cirrhosis, esophageal transection

Reprint requests
Ryo Nakanishi Second Department of Surgery, Juntendo University, School of Medicine
2-1-1 Hongo, Bunkyo-ku, Tokyo 113 JAPAN

Accepted
July 2, 1997

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