Authors
Khoronko Yu.V., Sidorov R.V., Sapronova N.G., Kosovtsev E.V., Khoronko E.Yu., Sarkisov A.E., Krivorotov N.A., Abdullaev K.I.
Rostov State Medical University, Rostov-on-Don
Abstract
To assess the severity of portal hypertension, a number of parameters are known, among which specialists often use the hepatic venous pressure gradient (HVPG). However, it is difficult to quantify the portal decompression achieved by portosystemic shunt surgery and, in particular, transjugular intrahepatic portosystemic shunt (TIPS procedure) surgery using HVPD.
Aim. To analyze the significance of parameters characterizing the pressure gradient in the portal and inferior vena cava systems (portosystemic pressure gradient), reflecting the severity of portal hypertension and the degree of portal decompression achieved by the TIPS procedure.
Material and Methods. The diagnostic value of parameters that quantitatively characterize the portosystemic pressure gradient before and after shunting procedure, as well as the effect of embolization of afferent to esophagogastric varices on the pressure in portal vein system, was studied. To achieve the goal of the study, out of a total of 287 patients who underwent in 2007-22 in surgical clinic of RostSMU of the TIPS procedure due to complicated portal hypertension, a group of patients (n = 36) operated on in 2020-22 was identified, that is, at the stage of mastering the technique of performing TIPS, when the influence of technical errors is reduced to a minimum. In addition to HVPG, porto-systemic pressure gradient (PSG) was calculated in patients, which is more accurate.
Results. The TIPS procedure in all patients achieved effective portal decompression, which was clinically confirmed by reduction of esophagogastric varices and of splenomegaly/hypersplenism, and ascites resorption. Initial values of HVPG and PSG were 16.54±5.79 (5 - 30.3) and 25.25±4.10 (19 - 37) mm Hg, respectively (r=0.78). Shunting led to a decrease of pressure in portal vein from 33.86±4.57 to 20.36±2.09 mm Hg (p<0.001). In turn, PSG also decreased, from 26.42±4.48 to 9.75±1.18 mm Hg (p = 0.00256).
Conclusion. 1. PSG, unlike HPVD, more accurately characterizes the portosystemic gradient in portal hypertension, since it is calculated from direct manometry data. 2. Selective embolization of inflow tracts to esophagogastric varices leads to an insignificant increase of PSG. 3. In turn, it is completely eliminated by the shunting stage of the TIPS procedure, providing effective portal decompression.
Keywords: portal hypertension, esophagogastric variceal bleeding, TIPS procedure, portosystemic pressure gradient.
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