Characterization of uncommon portosystemic collateral circulations in patients with hepatic cirrhosis

Qin Wu, Lijun Shen, Jindong Chu, Xuemei Ma, Bo Jin, Fanping Meng, Jinpin Chen, Yanling Wang, Libing Wu, Jun Han, Wenhui Zhang, Wei Ma, Huaming Wang, Hanwei Li, Qin Wu, Lijun Shen, Jindong Chu, Xuemei Ma, Bo Jin, Fanping Meng, Jinpin Chen, Yanling Wang, Libing Wu, Jun Han, Wenhui Zhang, Wei Ma, Huaming Wang, Hanwei Li

Abstract

The purpose of the present study was to characterize uncommon portosystemic collateral circulation in hepatic cirrhosis. Portosystemic uncommon collateral circulation (UCC) was detected, characterized and evaluated by a combination of spiral computed tomography angiography, three-dimensional imaging angiography and electronic gastroscopy in patients diagnosed with hepatic cirrhosis. In total, 118 cases with UCC were detected from a pool of 700 hepatic cirrhosis patients with portal hypertension. The incidence was 16.86% and included cases with splenic-renal, gastro-renal, paravertebral, retroperitoneal, gastric-splenic and cardio-phrenic angle vein shunts. The occurrence rate of UCC formation increased with the Child-Pugh grade. Compared with common collateral circulations, the incidence of severe esophageal or gastric fundus varicose veins, severe portal hypertensive gastropathy and the incidence of a large quantity of ascites was much lower in the patients with UCC (P<0.01), whereas the incidence of hepatic encephalopathy and chronic elevated blood ammonia levels was significantly higher (P<0.01). The incidence of uncommon portosystemic collateral circulation is extremely common in patients with liver cirrhosis and is associated with the Child-Pugh grades of hepatic function. UCC can aid in the relief of the complications derived from portal hypertension, but it may increase the incidence of hepatic encephalopathy and chronic elevated blood ammonia levels.

Keywords: collateral circulation; esophageal varicosity; gastric fundus varicosity; hepatic encephalopathy; liver cirrhosis; portal hypertension.

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Source: PubMed

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