Short-term hemodynamic effects of transjugular retrograde obliteration of gastric varices with gastrorenal shunt

Objectives: The purpose of this study was to investigate the short-term eff ects on portal hemodynamics of transjugular retrograde obliteration (TJO) o f gastric varices with gastrorenal shunt. Methods: Thirty patients with gas tric varices and a gastrorenal shunt were included in th is study. The pati ents ranged in age from 42 to 75 years (16 men and 14 women), and according to Child's classification, class A, B and C cirrhosis was seen in 1, 13 an d 16 patients, respectively. The portal blood flow was measured by an ultra sonic duplex Doppler system, and the wedged hepatic venous pressure was mea sured by hepatic venous catheterization, before and after TJO. Results: Com plete obliteration of the gastrorenal shunt and gastric varices was reveale d by retrograde inferior phrenic venography and computed tomography after T JO in all cases. The wedged hepatic venous pressure was significantly incre ased the day after TJO compared with that before therapy (257 +/- 71 vs. 30 7 +/- 73 mm H2O, p < 0.01). The portal venous flow was significantly increa sed 1 week after TJO compared with that before therapy (744 +/- 190 vs. 946 +/- 166 ml/min, p < 0.01). The serum albumin levels before and after TJO w ere 3.0 +/- 0.4 and 3.1 +/- 0.5 g/dl, respectively, and the total bilirubin levels were 1.5 +/- 0.7 and 1.5 +/- 0.8 mg/dl, respectively, neither of th ese parameters changing significantly. The plasma ammonia levels before and after TJO were 109 +/- 62 and 67 +/- 31 mug/dl, and the indocyanine green retention rates at 15 min were 31 +/- 13 and 24 +/- 13%, both showing a sig nificant change (p < 0.01 and p < 0.05, respectively). Conclusions: We conc lude that TJO increases portal blood flow which contributes to the decrease in plasma ammonia levels and the indocyanine green retention rate, althoug h increasing the wedged hepatic venous pressure. Copyright (C) 2000 S. Karg er AG. Basel.