Title: Efficacy of shunt vessel ligation for Abernethy malformation: a report of 7 cases
Abstract: Objective
To explore the feasibility and outcomes of shunt vessel ligationy for Abernethy malformation (AM).
Methods
Retrospective analysis was performed for the clinical data of 7 AM children undergoing shunt vessel ligation from May 2014 to August 2017. Preoperative examinations of vascular ultrasound and enhanced computed tomography (CT) failed to detect any slimming of portal vein trunk, portal vein or its branches. Clinical manifestations included small hepatic volume and hyperammonemia. There were inferior mesenteric vein & iliac vein shunt (n=5), splenic vein & left renal vein shunt (n=1) and portal vein trunk & inferior vena cava shunt (n=1). During operation, measuring the pressure of portal vein and contrasting radiography were performed via mesenteric vein prior to blockade. After blockade, the procedure was repeated. If portal vein trunk and its intrahepatic branch were visualized by radiography after blockade, Abernethy malformation typeⅡwas confirmed. During blockade, after 20-minute observations, if there was not any abnormality and the pressure was under 25cmH2O, shunt vessel was ligated completely. If pressure exceeded 25 cmH2O, shunt vessel was partially ligated and pressure was maintained at around 25 cmH2O. During re-operation, shunt vessel was completely ligated.
Results
AM typeⅡ was confirmed by radiography in all cases. After blockade, portal vein trunk and its intrahepatic branch expanded and blood inflow increased significantly. Ligation was one-stage (n=3) and two-stage (n=4). Two early cases underwent a Rex procedure simultaneously. Liver volume expanded markedly post-operation in all cases. At 2 weeks postoperatively, average liver volume increased by 207.00±54.29 ml with a growth rate of 41.50±13.43%.
Conclusions
Shunt vessel ligation is both feasible and effective for AM.
Key words:
Portal Vein; Malformation; Blood vessel; Ligation
Publication Year: 2019
Publication Date: 2019-04-15
Language: en
Type: article
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