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Clinical effects of “proximal” splenic artery (SA) embolization (Emb) in cirrhotics (c) with ascites
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A PROSPECTIVE RANDOMIZED TRIAL COMPARING ORTHOTOPIC VERSUS AUXILIARY PARTIAL LIVER TRANSPLANTATION IN THE PIG.
J.D. Blankensteijn~ D. Baumqartner] Th.H.N. Groenland 2 L.P. VQs 2 L.G.M. Kerkhofs~and O.T. Terpstra! Depts. of Surgery ] and Anestheslology~ 2 University Hospital Dijkzigt, 3015 GD Rotterdam, The Netherlands. Although orthotopic liver transplantation (OLT) is a well established form of liver transplantation, the operative trauma is prohibitive in many patients with end-stage liver cirrhosis because of the severe changes in intraoperative haemodynamics, especially during the anhepatic phase. Auxiliary partial liver transplantation (APLT) is a less extensive operative procedure than OLT, but until r~Dw it has never been proven to induce lesser cardiovascular depression during transplantation. We therefore studied the intraoperative haemodynamic changes comparing these two types of liver transplantation in the pig. Twentyeight Yorkshire pigs (20-30 kg BW) were randomly allocated to OLT (N=I5) or APLT (N=I3). After donorhepatectomy a resection of +40% of the graft was performed in case of APLT. During OLT a ver~-venous bypass was used. Intra-operative haemodynamic changes were monitored using a thermodilution pulmonary artery catheter. Values were compared using the Mann-Whitney test. Median duration of the portal flow interruption was shorter in APLT: 15 min vs. 47 min in OLT (p<0.002). APLT is less time consuming: median 165 min vs. 120 min. in OLT (p<0.02). NO significant difference in bloodloss was found: 400 ml in OLT vs. 500 ml in APLT. During the portal anastomosis the Cardiac Output dropped to 70.1% of the initial value in OLT and to 47.7% in APLT (P<0.02). After unclamping of the aorta after the arterial anastomosis, the systolic blood pressure dropped to 75 mm Hg in OLT and to 90 mm Hg in APLT (ns). From these data we conclude that APLT is a shorter procedure than OLT with a significantly shorter portal flow interruption, but it does not lead to better intraoperative haemodynamic conditions during the portal vein interruption, in the ab6ence of pre-existing portal hypertension and collateral circulation.
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CLINICAL EFFECTSOF "PROXIMAL" SPLENIC ARTERY (SA) EMBOLIZATION (Emb) IN CIRRHOTICS (c) WITH ASCITES.
G. Bombardieri, P.G. FaIappa*, G. De Rosa, T. Sabatini, A.R. Cotroneo*, M. De Cinque*, A.M. De Gaetano* and L. Rossi - I s t i t u t o di PatoIogia Medina and * I s t i t u t o di Radiologia, Universita Cattolica del Sacro Cuore, Rome, I t a l y Transcatheter SA Emb using Gianturco's steel spirals provides a proximal SA obstruction, while distal SA perfusion is obtained by anastomotic branches.After the experience of 52 consecutive SA Emb without c l i n i c a i | y important side effects, we performed SA Emb to c in which major problems occurred during medical treatment of ascites.Here we refer the c l i n i c a l effects of SA Emb in 12 c with ascites, 7 males and 5 females,aged 55~8 yea~s.7 of them were c l a s s i f i ed C class and 5 B, according to Child and Turcotte.5 had " r e f r a c t o r y " ascites,7 showed important d i u r e t i c side effects (4 had recurrent encephalopathy and 3 extreme weakness).In the 3-30 (mean 12) months follow-up a f t e r SA Emb:1)no adverse effects related to SA Emb were observed; 2)2 c died f o r hematemesis 6 and 24 months a f t e r SA Emb;3)aI] of the 5 c with " r e f r a c t o r y " ascites became responders to d i u r e t i c s (in 3/5 ascites disappeared);4)in patients s u f f e r i n g from d i u r e t i c side effects (encephalopathy or weakness) ascites disappeared without d i u r e t i c s (4/7)or with very low d i u r e t i c doses (3/7).No d i u r e t i c side effects were f u r t h e r l y observed;5) spIenomegaly was g r e a t l y reduced in a l l cases;6)ail patients referred a dramatic improvement of t h e i r l i f e q u a l i t y 2 months a f t e r SA Emb;7)a s i g n i f i c a n t r i s e of plasma Na+(from 127~4 to 13254.5 mEq/l,~
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A PROSPECTIVE RANDOMIZED TRIAL COMPARING ORTHOTOPIC VERSUS AUXILIARY PARTIAL LIVER TRANSPLANTATION IN THE PIG.
J.D. Blankensteijn~ D. Baumqartner] Th.H.N. Groenland 2 L.P. VQs 2 L.G.M. Kerkhofs~and O.T. Terpstra! Depts. of Surgery ] and Anestheslology~ 2 University Hospital Dijkzigt, 3015 GD Rotterdam, The Netherlands. Although orthotopic liver transplantation (OLT) is a well established form of liver transplantation, the operative trauma is prohibitive in many patients with end-stage liver cirrhosis because of the severe changes in intraoperative haemodynamics, especially during the anhepatic phase. Auxiliary partial liver transplantation (APLT) is a less extensive operative procedure than OLT, but until r~Dw it has never been proven to induce lesser cardiovascular depression during transplantation. We therefore studied the intraoperative haemodynamic changes comparing these two types of liver transplantation in the pig. Twentyeight Yorkshire pigs (20-30 kg BW) were randomly allocated to OLT (N=I5) or APLT (N=I3). After donorhepatectomy a resection of +40% of the graft was performed in case of APLT. During OLT a ver~-venous bypass was used. Intra-operative haemodynamic changes were monitored using a thermodilution pulmonary artery catheter. Values were compared using the Mann-Whitney test. Median duration of the portal flow interruption was shorter in APLT: 15 min vs. 47 min in OLT (p<0.002). APLT is less time consuming: median 165 min vs. 120 min. in OLT (p<0.02). NO significant difference in bloodloss was found: 400 ml in OLT vs. 500 ml in APLT. During the portal anastomosis the Cardiac Output dropped to 70.1% of the initial value in OLT and to 47.7% in APLT (P<0.02). After unclamping of the aorta after the arterial anastomosis, the systolic blood pressure dropped to 75 mm Hg in OLT and to 90 mm Hg in APLT (ns). From these data we conclude that APLT is a shorter procedure than OLT with a significantly shorter portal flow interruption, but it does not lead to better intraoperative haemodynamic conditions during the portal vein interruption, in the ab6ence of pre-existing portal hypertension and collateral circulation.
18
CLINICAL EFFECTSOF "PROXIMAL" SPLENIC ARTERY (SA) EMBOLIZATION (Emb) IN CIRRHOTICS (c) WITH ASCITES.
G. Bombardieri, P.G. FaIappa*, G. De Rosa, T. Sabatini, A.R. Cotroneo*, M. De Cinque*, A.M. De Gaetano* and L. Rossi - I s t i t u t o di PatoIogia Medina and * I s t i t u t o di Radiologia, Universita Cattolica del Sacro Cuore, Rome, I t a l y Transcatheter SA Emb using Gianturco's steel spirals provides a proximal SA obstruction, while distal SA perfusion is obtained by anastomotic branches.After the experience of 52 consecutive SA Emb without c l i n i c a i | y important side effects, we performed SA Emb to c in which major problems occurred during medical treatment of ascites.Here we refer the c l i n i c a l effects of SA Emb in 12 c with ascites, 7 males and 5 females,aged 55~8 yea~s.7 of them were c l a s s i f i ed C class and 5 B, according to Child and Turcotte.5 had " r e f r a c t o r y " ascites,7 showed important d i u r e t i c side effects (4 had recurrent encephalopathy and 3 extreme weakness).In the 3-30 (mean 12) months follow-up a f t e r SA Emb:1)no adverse effects related to SA Emb were observed; 2)2 c died f o r hematemesis 6 and 24 months a f t e r SA Emb;3)aI] of the 5 c with " r e f r a c t o r y " ascites became responders to d i u r e t i c s (in 3/5 ascites disappeared);4)in patients s u f f e r i n g from d i u r e t i c side effects (encephalopathy or weakness) ascites disappeared without d i u r e t i c s (4/7)or with very low d i u r e t i c doses (3/7).No d i u r e t i c side effects were f u r t h e r l y observed;5) spIenomegaly was g r e a t l y reduced in a l l cases;6)ail patients referred a dramatic improvement of t h e i r l i f e q u a l i t y 2 months a f t e r SA Emb;7)a s i g n i f i c a n t r i s e of plasma Na+(from 127~4 to 13254.5 mEq/l,~
Sll