Skip to content

We value your privacy

We use cookies to enhance your browsing experience, serve personalized ads or content, and analyze our traffic. By clicking "Accept All", you consent to our use of cookies.

Customize Consent Preferences

We use cookies to help you navigate efficiently and perform certain functions. You will find detailed information about all cookies under each consent category below.

The cookies that are categorized as "Necessary" are stored on your browser as they are essential for enabling the basic functionalities of the site. ... 

Always Active

Necessary cookies are required to enable the basic features of this site, such as providing secure log-in or adjusting your consent preferences. These cookies do not store any personally identifiable data.

No cookies to display.

Functional cookies help perform certain functionalities like sharing the content of the website on social media platforms, collecting feedback, and other third-party features.

No cookies to display.

Analytical cookies are used to understand how visitors interact with the website. These cookies help provide information on metrics such as the number of visitors, bounce rate, traffic source, etc.

No cookies to display.

Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors.

No cookies to display.

Advertisement cookies are used to provide visitors with customized advertisements based on the pages you visited previously and to analyze the effectiveness of the ad campaigns.

No cookies to display.

Portal pressure measurement

Sonopath Forum

Sonopath Forum

Portal pressure measurement

Hello

I performed a search but could not get a perfect answer so I thought I would ask the experts.

When performing surgery for a PSS, can ultrasound be used to extrapulate portal pressures relatively accurately or should manometers be used?

Hello

I performed a search but could not get a perfect answer so I thought I would ask the experts.

When performing surgery for a PSS, can ultrasound be used to extrapulate portal pressures relatively accurately or should manometers be used?

I have read that the average flow velocity is around 10cm/s in the dog portal vein. Pre-shunt I would assume it could be higher but if the PSS is ligated and portal systemic pressure increases we will get resistance and the flow should start to drop. Is this enought to correlate to pressures?  I did read on the basic search a case of a splenoazygous shunt where it was reccomended to monitor portal pressures with intra-operative US but I have not been able to find out the logistics of doing this.

I have read that this can be used to also ensure that the proper vessel is being ligated intra-operatively as apposed to using jejunal angiography which can be time consuming transporting to radiology.

Thanks. Looking forward to the comments. Brent.

Comments

EL
September 25, 2016 at 12:44 am -

Actually th epublished

Actually th epublished results that I know of are normals between 18-25 cm/sec forward flow of the portal vein. This being said there is a ton of variation on practivce here as Ive seen portal hypertension cases wiht a flow of 18 cm/sec and others of 12 cm/sec which makes more sense. 10 cm/sec would be portal hypertension in my experience with the proper factors…. but nvneouse flow is very unpredictable and you can create slow flow with dex domitor or other sedation or bradycardia…

Most surgeons I know just look for congestion of the pv and edema back up in th epancreas through the pancreatioduodenal vein. Panc edema is the first if not one of the first signs of poortal hypertension. I look for this in post shunt ligations as well as the portal velocity… splenic congestion comes next typically then eventually ascites and secondary shunting. Left gonadal vein is th etell all sign of portal hypertension but this is th enerd y confirmation:) Believe me the anatomical changes will be more consistent than the numbers. here are some portal hypertension cases to demonstrate more of wehat Im talking about.

http://sonopath.com/members/case-studies/search?text=portal+hypertension&species=All

 

particularly this end stage cirrhosis case

http://sonopath.com/members/case-studies/cases/0300528-kesat-cirrhosis

or this one clean for PHT post attenuation since none of the above PHT parameters were present so no need for the velocity

http://sonopath.com/members/case-studies/cases/follow-ultrasound-post-surgical-repair-portosystemic-shunt-4-year-old-mn-

or this early PHT cases form diffuse liver disease… note the pv velocity was 15-18 cm/sec at the pv junction with the pancreatic duodenal vein but clear panc edema and early ascites together with diffuse liver disease

http://sonopath.com/members/case-studies/cases/0300354-charlie-d-possible-cirrhosis

hope this helps

tosullivan
September 25, 2016 at 2:43 am -

Thanks. Great help

Thanks. Great help

Subscribe