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Current practice of anticoagulant in the treatment of splanchnic vein thrombosis secondary to acute pancreatitis

Hepatobiliary & Pancreatic Diseases International 2020年第2期19卷 116-121页

作者： William Norton Gabija Lazaraviciute George Ramsay Irene Kreis Irfan Ahmed Mohamed Bekheit Department of General Surgery Aberdeen Royal InfirmaryAberdeen AB252ZNUK Rowett Institute of Nutrition and Health University of AberdeenForesterhillAberdeen AB252ZDUK Clinical Effectiveness Unit Royal College of Surgeons of England35-43 Lincoln’s Inn FieldsHolbornLondon WC2A 3PEUK Department of Surgery El Kabbary HospitalEl KabbaryAlexandriaEgypt

Background:Severe acute pancreatitis is a common diagnosis in emergency general surgery and can be a cause of significant morbidity and mortality.A consequence of severe acute pancreatitis is thrombus in the splanchnic veins.These thrombi can potentially lead to bowel ischemia or hepatic failure.However,another complication of severe acute pancreatitis is retroperitoneal bleeding.At this time,it is unclear if treating patients for splanchnic vein thrombosis in the context of severe acute pancreatitis is associated with any outcome benefit.A systematic review might clarify this question.Data sources:A two-fold search strategy(one broad and one precise)looked at all published literature.The review was registered on PROSPERO(ID:CRD42018102705).MEDLINE,EMBASE,PubMed,Cochrane and Web of Science databases were searched and potentially relevant papers were reviewed indepen-dently by two researchers.Any disagreement was reviewed by a third independent researcher.Primary outcome was reestablishment of flow in the thrombosed vein versus bleeding complications.Results:Of 1462 papers assessed,a total of 16 papers were eligible for inclusion.There were no ran-domized controlled trials,2 were case series,5 retrospective single-center studies and 9 case reports.There were a total of 198 patients in these studies of whom 92(46.5%)received anticoagulation therapy.The rates of recanalization of veins in the treated and non-treated groups was 14%and 11%and bleeding complications were 16%and 5%,respectively.However,the included studies were too heterogeneous to undertake a meta-analysis.Conclusions:The systematic review highlights the lack evidence addressing this clinical question.There-fore a randomized controlled trial would be appropriate to undertake.

关键词： Severe acute pancreatitis splanchnic vein thrombosis Anticoagulant therapy

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splanchnic vein thrombosis in necrotizing acute pancreatitis: Detection by computed tomographic venography

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World Journal of Gastroenterology 2014年第44期20卷 16698-16701页

作者： Wei Jiang Jing Zhou Lu Ke Gang Li Zhi-Hui Tong Wei-Qin Li Jie-Shou Li Research Institute of General Surgery Jinling Hospital Medical School of Nanjing University

AIM: To assess the diagnostic accuracy of computed tomographic venography(CTV) for splanchnic vein thrombosis(SVT) detection in necrotizing acute pancreatitis(AP) patients.METHODS:Forty-three patients with necrotizing AP who underwent both CTV and digital subtraction angiography(DSA)within 3 d were analyzed in this retrospective comparative study.All CTV procedures were performed with a dual-source CT scanner.The presence and location of SVT were determined via blinded imaging data analyses.RESULTS:According to the DSA results,17(39.5%)of the total 43 patients had SVT.The sensitivity,specificity,positive and negative predictive values of CTV for SVT detection were 100%(95%CI:77.1%-100%),92.3%(95%CI:73.4%-98.7%),89.5%(95%CI:65.5%-98.2%)and 100%(95%CI:82.8%-100%),respectively.CONCLUSION:CTV is an effective examination for SVT detection in patients with necrotizing AP with high positive and negative predictive values.

关键词： splanchnic vein Thrombosis Necrotizing acute pancr

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splanchnic vasodilation and hyperdynamic circulatory syndrome in cirrhosis

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World Journal of Gastroenterology 2014年第10期20卷 2555-2563页

作者： Massimo Bolognesi Marco Di Pascoli Alberto Verardo Angelo Gatta Department of Internal Medicine-DIMED University of Padua Azienda Ospedaliera Università di Padova 35128 Padova Italy

Portal hypertension is a clinical syndrome which leads to several clinical complications,such as the formation and rupture of esophageal and/or gastric varices,ascites,hepatic encephalopathy and hepato-renal syndrome.In cirrhosis,the primary cause of the increase in portal pressure is the enhanced resistance to portal outflow.However,also an increase in splanchnic blood flow worsens and maintains portal hypertension.The vasodilatation of arterial splanchnic vessels and the opening of collateral circulation are the determinants of the increased splanchnic blood flow.Several vasoactive systems/substances,such as nitric oxide,cyclooxygenase-derivatives,carbon monoxide and endogenous cannabinoids are activated in portal hypertension and are responsible for the marked splanchnic vasodilatation.Moreover,an impaired reactivity to vasoconstrictor systems,such as the sympathetic nervous system,vasopressin,angiotensinⅡand endothelin-1,plays a role in this process.The opening of collateral circulation occurs through the reperfusion and dilatation of preexisting vessels,but also through the generation of new vessels.splanchnic vasodilatation leads to the onset of the hyperdynamic circulatory syndrome,a syndrome which occurs in pa-tients with portal hypertension and is characterized by increased cardiac output and heart rate,and decreased systemic vascular resistance with low arterial blood pressure.Understanding the pathophysiology of splanchnic vasodilatation and hyperdynamic circulatory syndrome is mandatory for the prevention and treatment of portal hypertension and its severe complications.

关键词： Portal hypertension splanchnic flow Splenic circul

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Effects of somatostatin analog on splanchnic hemodynamics and plasma glucagon level in portal hypertensive rats

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World Journal of Gastroenterology 1997年第4期3卷 20-22页

作者： WU ZhiYong, ZHANG XiaoJie, JIAO Zhe, CHEN ZhiPing and KUANG YaoLing

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关键词： portal hypertension octreotide glucagon splanchnic hemodynamics somatostatin analog

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Chronic intestinal ischemia and splanchnic blood-flow:Reference values and correlation with body-composition

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World Journal of Gastroenterology 2013年第6期19卷 882-888页

作者： Helle Damgaard Zacho Jens Henrik Henriksen Jan Abrahamsen Department of Clinical Physiology Viborg Regional Hospital Department of Clinical Physiology Hvidovre HospitalUniversity of Copenhagen

AIM:To determine the splanchnic blood flow and oxygen uptake in healthy-subjects and patients and to relate the findings to body-composition.METHODS:The total splanchnic blood flow (SBF) and oxygen uptake (SO2U) were measured in 20 healthy volunteers (10 women) and 29 patients with suspected chronic intestinal ischemia (15 women),age 40-85 years,prior to and after a standard meal.The method is based on the Fick principle using the continuous infusion of an indicator (99mTechnetium-labelled mebrofenin) and catheterization of an artery and the hepatic vein.An angiography of the intestinal arteries was performed during the same investigation.A whole-body dual-energy x-ray absorptiometry scan was performedin healthy volunteers to determine body composition.RESULTS:Angiography revealed no atherosclerotic lesions in the intestinal arteries.The mean baseline SBF was 1087mL/min (731-1390),and this value increased significantly to 1787 mL/min after the meal in healthy volunteers (P<0.001).The baseline SBF in patients was 1080 mL/min,which increased to 1718 mL/min postprandially (P<0.001).The baseline SBF was independent of age,sex,lean body mass and percentage of body fat.The mean meal-induced increase in SBF was equal to 282mL/min + 5.4mL/min × bodyweight,(P=0.025).The SO2U in healthy volunteers and patients was 50.7mL/min and 48.0mL/min,respectively,and these values increased to 77.5 mL/min and 75mL/min postprandially,respectively.Both baseline and postprandial SO2U were directly related to lean body mass.Age and sex exerted no impact on SO2U.CONCLUSION:A direct correlation between body weight and the postprandial increase in SBF was observed.The effect of body weight should be considered in the diagnosis of chronic intestinal ischemia.

关键词： splanchnic circulation Postprandial period Body composition Mesenteric vascular occlusion Middle aged

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Thoracic epidural anesthesia:Effects on splanchnic circulation and implications in Anesthesia and Intensive care

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World Journal of Critical Care Medicine 2015年第1期4卷 89-104页

作者： Antonio Siniscalchi Lorenzo Gamberini Cristiana Laici Tommaso Bardi Stefano Faenza Division of Anesthesiology Alma Mater Studiorum University of Bologna

AIM: To evaluate the currently available evidence on thoracic epidural anesthesia effects on splanchnic macro and microcirculation, in physiologic and pathologic conditions.METHODS:A Pub Med search was conducted using the Me SH database.Anesthesia,Epidural was always the first MeS H heading and was combined by boolean operator AND with the following headings:Circulation,splanchnic;Intestines;Pancreas and Pancreatitis;LiverFunction Tests.EMBASE,Cochrane library,ClinicalT rials.gov and clinicaltrialsregister.eu were also searched using the same terms.RESULTS:Twenty-seven relevant studies and four ongoing trials were found.The data regarding the effects of epidural anesthesia on splanchnic perfusion are conflicting.The studies focusing on regional macro-hemodynamics in healthy animals and humans undergoing elective surgery,demonstrated no influence or worsening of regional perfusion in patients receiving thoracic epidural anesthesia(TEA).On the other hand most of the studies focusing on micro-hemodynamics,especially in pathologic low flow conditions,suggested that TEA could foster microcirculation.CONCLUSION:The available studies in this field are heterogeneous and the results conflicting,thus it is difficult to draw decisive conclusions.However there is increasing evidence deriving from animal studies,that thoracic epidural blockade could have an important role in modifying tissue microperfusion and protecting microcirculatory weak units from ischemic damage,regardless of the effects on macro-hemodynamics.

关键词： Anesthesia Epidural Circulation splanchnic Intestine Microcirculation Pancreatitis Liver function tests

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Effect of laparoscopic abdominal surgery on splanchnic circulation: Historical developments

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World Journal of Gastroenterology 2014年第48期20卷 18165-18176页

作者： Sinan Hatipoglu Sami Akbulut Filiz Hatipoglu Ruslan Abdullayev Department of Surgery Adiyaman University Faculty of Medicine 02040 Adiyaman Turkey Department of Surgery and Liver TransplanInstitute Inonu University Faculty of Medicine 44280 Malatya Turkey Department of Obstetrics and Gynecology Adiyaman University Faculty of Medicine 02040 Adiyaman Turkey Department of Anesthesiology and Reanimation Adiyaman University Faculty of Medicine 02040 Adiyaman Turkey

With the developments in medical technology and increased surgical experience,advanced laparoscopic surgical procedures are performed successfully.Laproscopic abdominal surgery is one of the best examples of advanced laparoscopic surgery(LS).Today,laparoscopic abdominal surgery in general surgery clinics is the basis of all abdominal surgical interventions.Laparo scopica bdomina l surgery is associated with systemic and splanchnic hemodynamic alterations.Inadequate splanchnic perfusion in critically ill patients is associated with increased morbidity and mortality.The underlying pathophysiological mechanisms are still not well understood.With experience and with an increase inthe number and diversity of the resulting data,the pathophysiology of laparoscopic abdominal surgery is now better understood.The normal physiology and pathophysiology of local and systemic effects of laparoscopic abdominal surgery is extremely important for safe and effective LS.Future research projects should focus on the interplay between the physiological regulatory mechanisms in the splanchnic circulation(SC),organs,and diseases.In this review,we discuss the effects of laparoscopic abdominal surgery on the SC.

关键词： Laparoscopic abdominal surgery splanchnic circulat

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Modulation of splanchnic circulation:Role in perioperativemanagement of liver transplant patients

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World Journal of Gastroenterology 2016年第4期22卷 1582-1592页

作者： Ahmed Mukhtar Hany Dabbous Department of Anesthesia and Critical Care Cairo UniversityCairo 11562Egypt Department of Hepatology and Gastroenterology Ain Shams UniversityCairo 11566Egypt

splanchnic circulation is the primary mechanism thatregulates volumes of circulating blood and systemic blood pressure in patients with cirrhosis accompanied by portal hypertension. Recently, interest has been expressed in modulating splanchnic circulation in patients with liver cirrhosis, because this capability might produce beneficial effects in cirrhotic patients undergoing a liver transplant. Pharmacologic modulation of splanchnic circulation by use of vasoconstrictors might minimize venous congestion, replenish central blood flow, and thus optimize management of blood volume during a liver transplant operation. Moreover, splanchnic modulation minimizes any high portal blood flow that may occur following liver resection and the subsequent liver transplant. This effect is significant, because high portal flow impairs liver regeneration, and thus adversely affects the postoperative recovery of a transplant patient. An increase in portal blood flow can be minimized by either surgical methods(e.g., splenic artery ligation, splenectomy or portocaval shunting) or administration of splanchnic vasoconstrictor drugs such as Vasopressin or terlipressin. Finally, modulation of splanchnic circulation can help maintain perioperative renal function. splanchnic vasoconstrictors such as terlipressin may help protect against acute kidney injury in patients undergoing liver transplantation by reducing portal pressure and the severity of a hyperdynamic state. These effects are especially important in patients who receive a too small for size graft. Terlipressin selectively stimulates V1 receptors, and thus causes arteriolar vasoconstriction in the splanchnic region, with a consequent shift of blood from splanchnic to systemic circulation. As a result, terlipressin enhances renal perfusion by increasing both effective blood volume and mean arterial pressure.

关键词： splanchnic circulation Vasopressin agonists Portal blood flow Liver transplant Perioperative renalfunction

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Four-dimensional flow magnetic resonance imaging incirrhosis

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World Journal of Gastroenterology 2016年第1期22卷 89-102页

作者： Zoran Stankovic University Institute of Diagnostic Interventional and Pediatric RadiologyInselspital-University Hospital Bern3010 BernSwitzerland

Since its introduction in the 1970’s,magnetic resonance imaging(MRI)has become a standard imaging modality.With its broad and standardized application,it is firmly established in the clinical routine and an essential element in cardiovascular and abdominal imaging.In addition to sonography and computer tomography,MRI is a valuable tool for diagnosing cardiovascular and abdominal diseases,for determining disease severity,and for assessing therapeutic success.MRI techniques have improved over the last few decades,revealing not just morphologic information,but functional information about perfusion,diffusion and hemodynamics as well.Four-dimensional(4D)flow MRI,a time-resolved phase contrast-MRI with three-dimensional(3D)anatomic coverage and velocity encoding along all three flow directions has been used to comprehensively assess complex cardiovascular hemodynamics in multiple regions of the body.The technique enables visualization of 3D blood flow patterns and retrospective quantification of blood flow parameters in a region of interest.Over the last few years,4D flow MRI has been increasingly performed in the abdominal region.By applying different acceleration techniques,taking 4D flow MRI measurements has dropped to a reasonable scanning time of 8 to 12 min.These new developments have encouraged a growing number of patient studies in the literature validating the technique’s potential for enhanced evaluation of blood flow parameters within the liver’s complex vascular system.The purpose of this review article is to broaden our understanding of 4D flow MRI for the assessment of liver hemodynamics by providing insights into acquisition,data analysis,visualization and quantification.Furthermore,in this article we highlight its development,focussing on the clinical application of the technique.

关键词： Four-dimensional flow magnetic resonanceimaging Phase contrast-magnetic resonance imaging Liver cirrhosis Imaging technique Hemodynamics Bloodflow Visualization Quantification TIPS splanchnic system

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Hepatosplanchnic circulation in cirrhosis and sepsis

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World Journal of Gastroenterology 2015年第9期21卷 2582-2592页

作者： Meghan Prin Jan Bakker Gebhard Wagener Department of Anesthesiology College of Physicians and Surgeons of Columbia UniversityNew YorkNY 10032United States Department of Intensive Care Unit Erasmus University Medical Center3015 GD RotterdamThe Netherlands

Hepatosplanchnic circulation receives almost half of cardiac output and is essential to physiologic homeostasis.Liver cirrhosis is estimated to affect up to 1% of populations worldwide,including 1.5% to 3.3% of intensive care unit patients.Cirrhosis leads to hepatosplanchnic circulatory abnormalities and end-organ damage.Sepsis and cirrhosis result in similar circulatory changes and resultant multi-organ dysfunction.This review provides an overview of thehepatosplanchnic circulation in the healthy state and in cirrhosis,examines the signaling pathways that may play a role in the physiology of cirrhosis,discusses the physiology common to cirrhosis and sepsis,and reviews important issues in management.

关键词： Liver cirrhosis Sepsis splanchnic circulation Hepa

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