Clinical significance of patent paraumbilical vein in patients with liver cirrhosis

A patent paraumbilical vein (PUV) is a frequent finding in patients with ci rrhosis when studied by duplex Doppler ultrasound. There is controversy reg arding the clinical significance of this finding. We studied 50 patients wi th cirrhosis and portal hypertension as evidenced by the demonstration of e sophageal varices on endoscopy. All 50 patients were evaluated for a signif icant PUV (diameter of greater than or equal to3 mm) using duplex Doppler s onography. The patients were divided into two groups based on the size of e sophageal varices (group A with small varices, N = 30; group B with large v arices, N = 20). A significant PUV was seen in 21 (42%) patients. The patie nts with portosystemic encephalopathy had a significantly greater prevalenc e of PUV (70%) than those without (32%, P < 0.02). Of the group with large esophageal varices, 6 (30%) had a significant PUV, while in the group with small varices, 15 (50%) had a significant PUV (P > 0.05). In no patient wit h large varices did the PUV diameter exceed 6 mm, while in as many as six p atients with small varices, the PUV diameter exceeded 6 mm. A significantly enlarged PUV seen on duplex Doppler ultrasound in cirrhotics may have impo rtant hemodynamic consequences. Besides predisposing the patient to portosy stemic encephalopathy, it may also offer some protection against formation of large varices. In particular, a very large patent PUV (greater than or e qual to6 mm) might identify a subgroup of patients with small varices and t hus a lesser likelihood of variceal bleeding.