Comparison of portal venous flow in cirrhotic patients with and without paraumbilical vein patency using duplex-sonography

Aim: In a prospective study we examined the effect of paraumbilical vein pa tency on the portal venous blood flow in patients with liver cirrhosis by D uplex-sonography. In this context we investigated the influence of the aeti ology and the severity of cirrhosis on the development of venous paraumbili cal shunts. Method: In 70 patients (Child A: 16; Child B: 27; Child C: 27) with cirrhosis of different aetiologies the portal venous flow velocity, th e blood flow volume, and the diameter of the portal vein were examined by D uplex sonography after an overnight fast. Results: 16 patients had a patent paraumbilical vein. The mean portal venous flow velocity (19.2 +/- 7.8 cm/ s) and the flow volume (1.29 +/- 0.50 l/min) were significantly higher in p atients with paraumbilical vein patency than in patients without paraumbili cal shunts (14.4 +/- 4.6 cm/s; p = 0.029 and 0.88 +/- 0.34 l/min; p = 0.007 respectively). The prevalence of shunts of the paraumbilical vein in cirrh otics was significantly lower in category Child A (6.3%) than in Child B (2 5.9%; p = 0.011) and Child C (33.3%; p = 0.006). Conclusion: The occurrence of relatively high portal blood flow velocities in cirrhotics must remind the examiner of the potential existence of spontaneous portosystemic shunts . Those shunts must be carefully looked for with colour-Doppler ultrasound. In order to assess the true parenchymal blood flow we suggest to perform a dditional measurements of the right portal trunk and the left portal vein d istal to the shunt. With an increase in the severity of liver cirrhosis the incidence of paraumbilical vein patency rises.