2021 Volume 27 Issue 4 Pages 271-278
Aim of this study was to evaluate newly designed method to predict change in portal venous pressure (PVP) after partial splenic embolization (PSE). Subjects were 13 patients receiving PSE in whom free hepatic venous pressure (fHVP), wedged hepatic venous pressure (WHVP) and hepatic venous pressure gradient (HVPG) were measured before and after the prodedure. Splenic infarction rate (SIR) was measured on contrast-enhanced CT images between 1 and 3 weeks after PSE. Diameters of the celiac artery (CA), superior mesenteric artery (SMA), common hepatic artery (CHA) and splenic arteries (SA) were measured on contrast-enhanced CT images before PSE. The hemodynamics model for estimation of PVP was established under the following conditions: PVP was determined by blood flows through CA and SMA and the ratio of each flow was correlated with a diameter of each artery to the power of x (x＝4, 3, 2.33, 2 by fluid mechanics). Blood flows in SA and CHA were equivalent to that of CA and the ratio of SA flow and CAH flow relative to CA flow were determined as was in the ratio of CA flow and SMA flow, blood flow of SA decreased depending on SIR. Estimated ratios of decrease in PVP were compared to the ratios of decrease in HVPG after PSE procedures. Consequently, the average SIR was 57.5% and the decrease of HVPG after PSE relative to than at baseline was 2.7 mmHg, suggesting that the mean ratio of decrease in HVPG was 19% (SD: 8%). In contrast, mean estimated ratios of decrease in PVP after PSE was calculated as 23% (SD: 5%) when x value was set as 2, which shows significant correlation to the ratio of decrease in HVPG (p＝0.046). Thus, decrease in PVP can be estimated based on diameters of CA, SMA, SA and CHA before PSE and SIR after PSE.
