| Triple-phase computed tomography and intraoperative flow measurements improve the management of portosystemic shunts during liver transplantation. | |
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MedLine Citation:
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PMID: 18161777 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Ligation of portosystemic shunts in patients with cirrhosis undergoing liver transplantation has been recommended to avoid insufficient portal vein (PV) flow. Shunts are not always recognized pretransplantation because intraoperative PV flow assessment is not routinely attempted. As a result of a posttransplantation PV thrombosis in a recipient with a large portosystemic shunt and a PV flow <1 L/minute, we employed triple-phase computed tomography with vascular reconstruction and intraoperative graft flow measurement to determine the need for inflow modification in our next 16 patients with large portosystemic shunts. Subsequently, 6 patients with large portosystemic shunts and PV flows <or=1 L/minute underwent inflow modification at the time of transplantation to improve venous graft inflow. One patient with PV thrombosis had PV replacement without shunt ligation. Two patients with large splenorenal shunts and extensive PV thrombosis had left renoportal bypass. In 7 patients with large portosystemic shunts and PV flow greater than 1 L/minute, inflow modification was not attempted, to avoid excessive venous inflow that could jeopardize hepatic artery flow via the hepatic artery buffer response. In conclusion, sustained good graft function and inflow were achieved in all 16 patients. |
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Authors:
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Federico N Aucejo; Koji Hashimoto; Cristiano Quintini; Dympna Kelly; David Vogt; Charles Winans; Bijan Eghtesad; Mark Baker; John Fung; Charles Miller |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society Volume: 14 ISSN: 1527-6465 ISO Abbreviation: Liver Transpl. Publication Date: 2008 Jan |
Date Detail:
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Created Date: 2008-01-02 Completed Date: 2008-03-11 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100909185 Medline TA: Liver Transpl Country: United States |
Other Details:
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Languages: eng Pagination: 96-9 Citation Subset: IM |
Copyright Information:
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(c) 2007 AASLD. |
Affiliation:
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Departments of General Surgery and Radiology, Cleveland Clinic, Cleveland, OH 44195, USA. faucejo@hotmail.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Female Graft Survival Humans Liver Circulation / physiology Liver Cirrhosis / surgery* Liver Transplantation / methods* Male Middle Aged Monitoring, Intraoperative / methods* Portasystemic Shunt, Surgical / methods* Postoperative Complications / prevention & control Retrospective Studies Tomography, X-Ray Computed / methods* Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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