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
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
Thanks. Great help
Thanks. Great help