SUPERIOR MESENTERIC-ARTERY IMPEDANCE IN CHRONIC LIVER-DISEASES - RELATIONSHIP WITH DISEASE SEVERITY AND PORTAL CIRCULATION

Objective: The increase of splanchnic blood flow volume in liver cirrh osis is attributed to decreased arterial resistance. The aim of this s tudy was to noninvasively investigate superior mesenteric artery imped ance in patients with chronic liver diseases and to assess its relatio nship with portal hemodynamics and with clinical parameters. Methods: Superior mesenteric artery (SMA) pulsatility (SMA-PI) and resistance ( SMA-RI) indices and portal vein flow parameters (velocity, volume, and congestion index) were measured by duplex-Doppler ultrasound in 14 pa tients with chronic hepatitis, in 73 cirrhotics, in 30 liver transplan t recipients, and in 31 control subjects. Results: SMA-PI significantl y differed among the five groups (p < 0.0001), being lower in cirrhoti cs (2.55 +/- 0.70) and transplanted patients (2.77 +/- 0.69) than in c hronic hepatitis (3.28 +/- 0.57) and control subjects (3.42 +/- 0.92), SMA-PI was lower in ascitic cirrhosis (2.40 +/- 0.71) than in compens ated cirrhosis (2.71 +/- 0.70) (p < 0.01) and in cirrhotics with large varices (2.30 +/- 0.67) than in those without varices (2.75 +/- 0.65) (p < 0.05), Moreover SMA-PI correlated with numeric Child-Pugh score (r = -0.28) and portal vein congestion index (r = -0.36), Conclusion: Hyperdynamic splanchnic circulation, noninvasively assessed by a decre ase of mesenteric artery impedance, occurs in cirrhosis since the earl y stage of the disease and tends to worsen in relation to liver failur e and the severity of portal hypertension. Furthermore, the persistent SMA-PI decrease in transplant recipients suggests a consistent contri bution to this circulatory alteration from a patent portosystemic coll ateral circulation. (Am J Gastroenterol 1998;93:1925-1930, (C) 1998 by Am. Cell. of Gastroenterology).