Vascular syndromes in liver cirrhosis

  • Botros Shenoda
  • Joseph BoselliEmail author
Clinical Review


Liver cirrhosis is associated with multiple vascular syndromes affecting almost all body systems. Many of these syndromes are directly related to impaired liver function and sometimes reversible after liver transplantation while others arise secondary to portal hypertension and ascites. Altered expression of angiogenic and vasoactive compounds (most importantly nitric oxide), endothelial dysfunction, dysregulated neurohormonal control, and systemic inflammatory state play differential roles in mediating homeostatic instability and abnormal vasogenic response. Important vascular features encountered in liver disease include portal hypertension, splanchnic overflow, abnormal angiogenesis and shunts, portopulmonary syndrome, hepatopulmonary syndrome, and systemic hyperdynamic circulation. Redistribution of effective circulatory volume deviating from vital organs and pooling in splanchnic circulation is also encountered in liver patients which may lead to devastating outcomes as hepatorenal syndrome. Etiologically, vascular syndromes are not isolated phenomena and vascular dysfunction in one system may lead to the development of another in a different system. This review focuses on understanding the pathophysiological factors underlying vascular syndromes related to chronic liver disease and the potential links among them. Many of these syndromes are associated with high mortality, thus it is crucial to look for early biomarkers for these syndromes and develop novel preventive and therapeutic strategies.


Liver cirrhosis Portal hypertension Portopulmonary hypertension Hepatopulmonary syndrome Hepatorenal syndrome 


Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest.

Human rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

For this type of study, informed consent is not required.


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Copyright information

© Japanese Society of Gastroenterology 2019

Authors and Affiliations

  1. 1.Department of MedicineDrexel University College of MedicinePhiladelphiaUSA
  2. 2.Drexel Internal MedicinePhiladelphiaUSA

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