Effect of portal venous flow on the outcome of hepatic arterial embolization

This poster is published under an open license. Please read the disclaimer for further details.

Congress:

ECR 2017

Poster Number:

C-1595

Type:

Educational Exhibit

Keywords:

Ischaemia / Infarction, Infection, Embolism / Thrombosis, Technical aspects, Embolisation, Complications, MR-Angiography, Catheter venography, Catheter arteriography, Liver, Interventional vascular, Abdomen

Authors:

S. Wassef¹, S. T. Laroia²; ¹52242, IA/US, ²Iowa city, IA/US

DOI:

10.1594/ecr2017/C-1595

DOI-Link:

https://dx.doi.org/10.1594/ecr2017/C-1595

Fig. 1: Changes of portal hypertension including splenomegaly and collateral...

Fig. 2: Contrast enhanced CT in the coronal (A) and axial (B) CT showing nonocclusive...

Fig. 4: portal hypertension with retrograde flow in main (A), left (B), and right (C)...

Fig. 5: Image A show biphasic and to and fro in the main portal vein. Image B shows...

Learning objectives

Upon reviewing this educational exhibit, the reader will recognize the importance of assessing portal venous flow prior to hepatic arterial embolization. The reader will also be familiar with the different imaging methods available to assess portal venous flow.

Background

The liver receives a dual blood supply from the hepatic portal vein and hepatic arteries with the hepatic portal vein delivering approximately 75% of the hepatic blood supply. Impaired portal venous flow prior to hepatic artery embolization can lead to complications including liver necrosis, infection and abscess formation, and liver failure.

Findings and procedure details

Hepatic blood flow: The liver receives a dual blood supply from both the portal vein and hepatic arteries. While the hepatic portal vein supplies around 75% of the liver's blood supply volume, however it is predominantly venous blood drained from the spleen and the gastrointestinal hence poor in oxygen but rich nutrients. On the other hand the hepatic arteries supply arterial blood to the liver accounting for the remainder of its blood flow. This is richer in oxygen but poor in nutrients. The biliary system...

Conclusion

Prior to hepatic arterial embolization, it is essential to evaluate the portal venous flow. Portal venous flow can be assessed pre-procedurally with ultrasound, computed tomography, or magnetic resonance angiography. It can also be evaluated intra-procedurally by catheter conventional angiography. Familiarity with the imaging findings of impaired portal venous flow is essential in preventing complications of hepatic arterial embolization. Knowledge of portal vein hemodynamic features can be important in determining the type of therapy to be used.

Personal information

References

Albacete RA, Matthews MJ, Saini N. Portal vein thromboses in malignant hepatoma. Ann Intern Med 1967; 67:337-348. Arii S, Tanaka J, Yamazoe Y, et al. Predictive factors for intrahepatic recurrence of hepatocellular carcinoma after partial hepatectomy. Cancer 1992; 69:913-919. Arora A, Rajesh S, Meenakshi YS, Sureka B, Bansal K, Sarin SK. Spectrum of hepatofugal collateral pathways in portal hypertension: an illustrated radiological review. Insights Imaging. 2015 Oct. 6 (5):559-72. Baysal T, D’Agostino HB, Serra EE, Valji K, Rose SC, Kinney TB. Supraumbilical dermal sclerosis and...