Portal Venous Deprivation in Patients with Portosystemic Shunts and Its Effect on Liver Tumors
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In brief
In brief
This retrospective study of 45 pediatric patients with congenital portosystemic shunts demonstrates that absence of intrahepatic portal venous flow significantly increases liver tumor risk (92% vs 29%). Radiological assessment of portal venous anatomy and hepatic arterial compensation provides critical prognostic information for surgical planning.
Written by the GCMD Library team from the article.
Aims
To outline the use of radiological investigations in patients with congenital portosystemic shunts (CPS) and to assess the degree of portal venous deprivation in relation to the development of liver tumors.
Methods
Single center retrospective cohort study of all patients with CPS referred from 1990 to 2016. Radiological investigations were reviewed for the presence of intrahepatic portal veins. Two groups were defined: Group 1 — without evidence of preservation of an intrahepatic portal venous system and, Group 2 — with evidence of intrahepatic portal venous flow. These groups were compared for the development of liver tumors, serum ammonia, and nature of subsequent surgical intervention. The ratio of infraceliac to supraceliac aortic diameter and hepatic enhancement in biphasic CT scans were also used to infer hepatic arterial in-flow and compared to age matched controls. Nonparametric tests were used throughout. A P value of 0.05 was considered significant. Data are quoted as median (IQR).
Results
45 patients (Group 1, n = 12: Group 2, n = 33) were investigated for CPS at a median age of 8 months (1 month–14 years). Liver tumors were more common in Group 1 than Group 2 [11/12 (92%) versus 10/33 (29%); P