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Kato S, Sakamori R, Yamada R, Murai K, Yoshioka T, Tahata Y, Shigekawa M, Kodama T, Hikita H, Hongyo H, Ono Y, Higashihara H, Tatsumi T, Takehara T. The First Case of Coil Embolization for Left Gastric Vein Aneurysm with Liver Cirrhosis: A Case Report and Review of the Literature. Intern Med 2021; 60:2617-2622. [PMID: 33678740 PMCID: PMC8429308 DOI: 10.2169/internalmedicine.6565-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We herein report the first case of interventional radiology for a left gastric vein aneurysm with a gastrorenal shunt. The etiology of the aneurysm was considered secondary to portal hypertension and liver cirrhosis due to hepatitis B virus infection. As the aneurysm was asymptomatic but had a tendency to expand, we successfully performed coil embolization for the aneurysm through a gastrorenal shunt.
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Affiliation(s)
- Seiya Kato
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Japan
| | - Ryotaro Sakamori
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Japan
| | - Ryoko Yamada
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Japan
| | - Kazuhiro Murai
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Japan
| | - Teppei Yoshioka
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Japan
| | - Yuki Tahata
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Japan
| | - Minoru Shigekawa
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Japan
| | - Takahiro Kodama
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Japan
| | - Hayato Hikita
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Japan
| | - Hidenari Hongyo
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Japan
| | - Yusuke Ono
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Japan
| | - Hiroki Higashihara
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Japan
| | - Tomohide Tatsumi
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Japan
| | - Tetsuo Takehara
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Japan
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Schilardi A, Ciavarella A, Carbone M, Antonica G, Berardi E, Sabbà C. A large asymptomatic portal vein aneurysm in an old man. Clin Case Rep 2021; 9:15-18. [PMID: 33489127 PMCID: PMC7813097 DOI: 10.1002/ccr3.3365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/23/2020] [Accepted: 08/24/2020] [Indexed: 12/21/2022] Open
Abstract
Ultrasound (US) is a useful tool in diagnosis and follow-up of portal vein aneurysms (PVA). In the absence of international surgical guidelines on PVAs, US can be effectively used in follow-up of asymptomatic patients not suitable for surgery.
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Affiliation(s)
- Andrea Schilardi
- Clinica Medica ‘Cesare Frugoni’Interdisciplinary Department of MedicineUniversity of BariBariItaly
| | - Alessandro Ciavarella
- Clinica Medica ‘Cesare Frugoni’Interdisciplinary Department of MedicineUniversity of BariBariItaly
| | - Mariangela Carbone
- Section of Diagnostic ImagingInterdisciplinary Department of MedicineUniversity of BariBariItaly
| | - Gianfranco Antonica
- Clinica Medica ‘Cesare Frugoni’Interdisciplinary Department of MedicineUniversity of BariBariItaly
| | - Elsa Berardi
- Clinica Medica ‘Cesare Frugoni’Interdisciplinary Department of MedicineUniversity of BariBariItaly
| | - Carlo Sabbà
- Clinica Medica ‘Cesare Frugoni’Interdisciplinary Department of MedicineUniversity of BariBariItaly
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Computed tomography evaluation of patent paraumbilical vein and its aneurysm in relation to other portosystemic collateral channels in patients with liver cirrhosis and portal hypertension. Pol J Radiol 2019; 84:e112-e117. [PMID: 31019603 PMCID: PMC6479138 DOI: 10.5114/pjr.2019.83135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/21/2018] [Indexed: 01/13/2023] Open
Abstract
Purpose The aim of the study was to evaluate the relationship between the diameter and aneurysmal dilatation of the paraumbilical vein (PUV) and the presence of portosystemic collateral shunts and their relationship with age and portal vein diameter. Material and methods The retrospective analysis, performed in the II Department of Radiology, Medical University Hospital in Warsaw, included 126 patients (77 males and 49 females) with patent umbilical vein and signs of portal hypertension due to liver cirrhosis. All patients underwent contrast enhanced abdominal CT. The average age was 54.7 ±12.98. We analysed the number and type of portosystemic collateral channels in respect of age, sex, presence of oesophageal varices, and the diameter of the paraumbilical vein and the portal vein. Results Our results disclosed statistically significant negative correlation between patient age and diameter of paraumbilical vein, number of portosystemic collateral channels and diameter of portal vein and positive correlation between diameter of paraumbilical vein and diameter of portal vein. A statistically significant difference in diameter of portal vein and number of collateral channels was found in groups with and without oesophageal varices. No significant difference in age and portal vein diameter was found in these groups. Conclusions Our study showed that younger patients with liver cirrhosis are characterised by wider paraumbilical veins and higher number of portosystemic collateral channels. The presence of oesophageal varices does not correlate with age, sex, diameter of paraumbilical vein, and number of collateral portosystemic channels.
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Abstract
Portal vein aneurysm is an unusual vascular dilatation of the portal vein, which was first described by Barzilai and Kleckner in 1956 and since then less than 200 cases have been reported. The aim of this article is to provide an overview of the international literature to better clarify various aspects of this rare nosological entity and provide clear evidence-based summary, when available, of the clinical and surgical management. A systematic literature search of the Pubmed database was performed for all articles related to portal vein aneurysm. All articles published from 1956 to 2014 were examined for a total of 96 reports, including 190 patients. Portal vein aneurysm is defined as a portal vein diameter exceeding 1.9 cm in cirrhotic patients and 1.5 cm in normal livers. It can be congenital or acquired and portal hypertension represents the main cause of the acquired version. Surgical indication is considered in case of rupture, thrombosis or symptomatic aneurysms. Aneurysmectomy and aneurysmorrhaphy are considered in patients with normal liver, while shunt procedures or liver transplantation are the treatment of choice in case of portal hypertension. Being such a rare vascular entity its management should be reserved to high-volume tertiary hepato-biliary centres.
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Bertocchini A, d'Ambrosio G, Grimaldi C, del Prete L, di Francesco F, Falappa P, Monti L, de Ville de Goyet J. Prehepatic portal hypertension with aneurysm of the portal vein: unusual but treatable malformative pattern. J Pediatr Surg 2014; 49:436-40. [PMID: 24650473 DOI: 10.1016/j.jpedsurg.2013.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 06/09/2013] [Accepted: 06/10/2013] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Portal vein aneurysms (PVAs) are usually located at the vein trunk or at its bifurcation, rarely intra-hepatic, or at the umbilical portion. Etiology remains unclear. METHODS Three children with PVA were identified over a 5-year period. PVA anatomy was assessed by Doppler Ultrasound, Angio CT/MRI, and trans-jugular retrograde portography. RESULTS Three children with intrahepatic PVA (including the umbilical portion) were identified during assessment for pre-hepatic portal hypertension: all had splenomegaly and hypersplenism. One presented with massive variceal bleeding. In two cases, a portal vein cavernoma was found, and in the third a severe stricture at the portal bifurcation was observed. Restoration of portal venous flow was achieved by a meso-Rex bypass in two cases and transposing the PV into the Rex in one. High hepatopetal portal flow was restored immediately, with follow-up confirming long-term patency and resolution of signs of portal hypertension with time. CONCLUSIONS These original observations suggest a common initial malformative pattern consisting of a portal venous stricture/web causing a post-stenotic aneurysmal dilatation of the intrahepatic portal branches complicated by thrombosis and cavernomatous transformation of the portal vein trunk. Importantly, the Meso-Rex bypass allows restoring a normal portal flow and cures the portal hypertension.
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Affiliation(s)
- Arianna Bertocchini
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy.
| | - Giuseppe d'Ambrosio
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Chiara Grimaldi
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Laura del Prete
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Fabrizio di Francesco
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Piergiorgio Falappa
- Interventional Radiology Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Lidia Monti
- Hepato-biliary Radiology Unit, Department of Imaging, Bambino Gesù Childrens Hospital, Roma, Italy
| | - Jean de Ville de Goyet
- Hepato-biliary and Transplant Surgery Unit, Department of Surgery and Transplantation Centre, Bambino Gesù Childrens Hospital, Roma, Italy
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Bertolini G, Caldin M. Computed tomography findings in portal vein aneurysm of dogs. Vet J 2012; 193:475-80. [PMID: 22269874 DOI: 10.1016/j.tvjl.2011.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Revised: 12/09/2011] [Accepted: 12/14/2011] [Indexed: 01/16/2023]
Abstract
In this retrospective study, the appearances of extrahepatic and intrahepatic portal vein aneurysms (PVAs) in dogs were evaluated using multidetector computed tomography (CT). Data from 3060 dogs that underwent abdominal CT were reviewed for focal portal vein dilatation. PVAs were detected in 15/3060 (0.49%) dogs. The bodyweights of dogs with PVAs were significantly higher than the bodyweights of dogs without aneurysms (P=0.0001). Male sex was also significantly associated with PVAs (OR=6.23). Boxers were predisposed to the development of PVA (OR=11.88). Extrahepatic PVAs were always located in the portal vein at the level of the gastroduodenal vein insertion and were saccular in 10/15 dogs and fusiform in 5/15 dogs. One dog had an additional intrahepatic aneurysm of the umbilical part of the left intrahepatic portal branch. No dogs had clinical signs related to the PVA(s), although one dog developed a portal vein thrombosis in the site of the aneurysm.
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Affiliation(s)
- G Bertolini
- San Marco Veterinary Clinic, Via Sorio 114/c, 35141 Padua, Italy.
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Sfyroeras GS, Antoniou GA, Drakou AA, Karathanos C, Giannoukas AD. Visceral venous aneurysms: clinical presentation, natural history and their management: a systematic review. Eur J Vasc Endovasc Surg 2009; 38:498-505. [PMID: 19560947 DOI: 10.1016/j.ejvs.2009.05.016] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 05/26/2009] [Indexed: 02/05/2023]
Abstract
AIM Aneurysms of the visceral veins are considered rare clinical entities. The aim is to assess their clinical presentation, natural history and management. METHODS An electronic search of the pertinent English and French literature was undertaken. All studies reporting on aneurysms of visceral veins were considered. Cases describing patients with arterial-venous fistulae and extrahepatic or intra-hepatic portosystemic venous shunts were excluded. RESULTS Ninety-three reports were identified, including 176 patients with 198 visceral venous aneurysms. Patients' age ranges from 0 to 87 years, and there is no apparent male/female preponderance. The commonest location of visceral venous aneurysms is the portal venous system (87 of 93 reports, 170 of 176 patients, 191 of 198 aneurysms). Aneurysms of the renal veins and inferior mesenteric vein are also described. Portal system venous aneurysms were present with abdominal pain in 44.7% of the patients, gastrointestinal bleeding in 7.3%, and are asymptomatic in 38.2%. Portal hypertension is reported in 30.8% and liver cirrhosis in 28.3%. Thrombosis occurred in 13.6% and rupture in 2.2% of the patients. Adjacent organ compression is reported in 2.2% (organs compressed: common bile duct, duodenum, inferior vena cava). The management ranged from watchful waiting to intervention. In 94% of the cases, aneurysm diameter remained stable and no complications occurred during follow-up. In most of the cases, indications for operation were symptoms and complications. Six cases of renal vein aneurysm are reported; three of them were asymptomatic. Three of these patients were treated surgically. CONCLUSION The most frequent location of visceral venous aneurysms is the portal venous system. They are often associated with cirrhosis and portal hypertension. They may be asymptomatic or present with abdominal pain and other symptoms. Watchful waiting is an appropriate treatment, except when complications occur. Most common complications are aneurysm thrombosis and rupture. Other visceral venous aneurysms are extremely rare.
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Affiliation(s)
- G S Sfyroeras
- Department of Vascular Surgery, University Hospital of Larissa, University of Thessaly Medical School, Larissa, Greece
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Lee TP, Lu HC, Chou YH, Tiu CM, Chiou SY, Chiou HJ, Wang HK. Portal Vein Aneurysm: A Case Report and Review of the Literature. J Med Ultrasound 2009. [DOI: 10.1016/s0929-6441(09)60016-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Portal venous system aneurysms: imaging, clinical findings, and a possible new etiologic factor. AJR Am J Roentgenol 2007; 189:1023-30. [PMID: 17954635 DOI: 10.2214/ajr.07.2121] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aims of this study were to present the prevalence, imaging and clinical findings, and possible causes of portal venous system aneurysms. MATERIALS AND METHODS From 1998 to 2006, a total of 38 portal venous system aneurysms identified in 25 patients were retrospectively reviewed. The data of seven patients diagnosed using color Doppler sonography or CT before March 2004 were not consecutive, but the data recorded thereafter comprised the analysis of 4,186 consecutive patients who underwent routine abdominal MDCT. The patients were 14 men and 11 women (mean age -/+ SD, 53 -/+ 17 years). RESULTS The prevalence of portal venous system aneurysm among 4,186 consecutive patients was 0.43%. There were no differences with respect to patient age, patient sex, and intrahepatic or extrahepatic location of aneurysm between those with and those without portal venous system aneurysm. Seven of the 25 patients with portal venous system aneurysm were symptomatic because of portal vein thrombosis, and six of them had recurrence. These patients had significantly larger aneurysms than those without symptoms. Four of those seven symptomatic patients evaluated for thrombophilia had an underlying defect. Other associated findings were splenomegaly (n = 16), portal hypertension (n = 8), cirrhosis (n = 3), psoriasis (n = 2), portal vein variation (n = 1), chronic pancreatitis (n = 1), and cutis laxa (n =1). CONCLUSION Portal venous system aneurysms were rare in our study group but occurred more frequently than previously thought. All thrombosed aneurysms, most with a recurrence, were symptomatic and larger in patients with symptoms of portal venous system aneurysm than in those without symptoms. There were no differences among patients with portal venous system aneurysm and those without portal venous system aneurysm with respect to patient age and patient sex. Among those with aneurysms, there was no difference between subjects with intrahepatic versus extrahepatic aneurysms. A thrombophilic defect probably played a role in development of thrombosis in the portal venous system aneurysm.
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Ho CM, Tsai SF, Lin RK, Liang PC, Sheu TWH, Hu RH, Lee PH. Computer Simulation of Hemodynamic Changes After Right Lobectomy in a Liver with Intrahepatic Portal Vein Aneurysm. J Formos Med Assoc 2007; 106:617-23. [PMID: 17711794 DOI: 10.1016/s0929-6646(08)60018-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/PURPOSE Intrahepatic portal vein aneurysm is rare and its natural history is unknown. A 22-year-old healthy man, who wished to donate part of his liver to his diseased father, was incidentally diagnosed to have an intrahepatic portal vein aneurysm. The surgical decision of performing live donor hepatectomy for such a patient is normally difficult. We combined modern imaging reconstruction technologies with scientific computing as a new modality to foresee the risks of surgical complications. METHODS Cross-sectional computed tomography images were used to reconstruct the three-dimensional image of portal vein distribution using the 3D-Doctor v3.5 software. The reconstructed images were further employed to generate surface and interior meshes with CFX software. Simulated hemodynamic changes in velocity, pressure, and wall stress were determined for the right lobectomy case pre- and postoperatively. RESULTS The simulation results indicated that aneurismal pressure would be elevated significantly to 12.03 mmHg after operation. The left segmental portal venous blood flow would increase from 2.95- to 4.25-fold. The area near the branch point of one left segmental portal vein, which supplies blood to liver segment 4, and the portal vein aneurysm would endure high shear stress gradient. The resulting elevated aneurismal pressure may cause the thin wall to enlarge and rupture, while the high shear stress gradient would lead to vascular endothelial cell injury. Living donor surgery was not recommended hemodynamically based on the simulated results. CONCLUSION Scientific computing and modern imaging technologies can be applied together to aid surgeons to make the best decision in difficult clinical situations.
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Affiliation(s)
- Cheng-Maw Ho
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Pey F, Bureau C, Otal P, Vinel JP, Rousseau H. Anomalies congénitales et acquises du système porte. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1155-1976(07)41406-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
Portal vein aneurysm is an unusual vascular abnormality. We report a rare case of a huge intrahepatic portal vein aneurysm at the umbilical portion with hepatic encephalopathy. Abdominal contrast-enhanced dynamic computed tomography and angiography clearly showed a well-circumscribed, 50 x 40-mm portal vein aneurysm at the umbilical portion with portohepatic venous shunt. To our knowledge, this is the largest intrahepatic portal vein aneurysm ever reported.
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Affiliation(s)
- T Kaido
- Department of Surgery, Otsu Municipal Hospital, 2-9-9-Motomiya, Otsu, Shiga 520-0804, Japan.
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