Advertisement

Doppler Flowmetry—Clinical Applications in Portal Hypertensive Patients

  • Luigi Bolondi
  • Stefano Gaiani
  • Luigi Barbara

Abstract

It is unanimously recognized that in the clinical assessment of portal hypertensive patients there are some unresolved hemodynamic problems that could be alleviated from a non-invasive hemodynamic technique applicable to large unselected series of patients. A substantial contribution to the understanding of the pathophysiology and the natural history of portal hypertension, to the assessment of bleeding risks and the evaluation of the effect of hormones and drugs on the portal venous system would be achieved by the measurement of flow in the portal vein and its tributaries as well as in collateral pathways and splanchnic arteries. In many instances, especially as far as the humoral regulation of splanchnic circulation and the effect of vasoactive drugs are concerned, the direction and the percentage of changes of flow velocity and volume provide enough information. Therefore it can be understood why in recent years there has been a remarkable increase in interest concerning the use of Doppler flowmetry for the investigation of portal hypertensive patients. Areas where this new technique is able to provide useful and reliable data have been recently defined in a Consensus Conference held in Bologna (Italy) [1]. On the basis of this consensus and on the most important papers published in the literature, this chapter will try to offer a comprehensive overview of current clinical applications and an insight into areas requiring further research with Doppler flowmetry.

Keywords

Portal Vein Inferior Vena Cava Portal Hypertension Hepatic Vein Portal Venous System 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Barbara L (1990) Consensus Conference “The value of Doppler US in the study of hepatic hemodynamics”. J Hepatol 10: 353–355.CrossRefGoogle Scholar
  2. 2.
    Granger HJ, Richardson PDI, Kvietys PR, Mortillaro NA (1980) Intestinal blood flow. Gastroenterology 78: 837PubMedGoogle Scholar
  3. 3.
    Moreno AH, Burchell AR, Van der Voude R, Burke JH (1967) Respiratory regulation of splanchnic and systemic venous return. Am J Physiol 213: 455–465PubMedGoogle Scholar
  4. 4.
    Rabinovici N, Navot N (1980) The relationship between respiration, pressure and flow distribution in the vena cava and portal and hepatic veins. Surg Gynecol Obstet 151: 753–763PubMedGoogle Scholar
  5. 5.
    Bolondi L, Gandolfi L, Arienti V, Caletti GC, Corcioni E, Gasbarrini G, Labò G (1982) Ultrasonography in the diagnosis of portal hypertension: Diminished response of portal vessels to respiration. Radiology 142: 167–172PubMedGoogle Scholar
  6. 6.
    Moreno AH (1964) Perpetuation of cirrhotic ascites as a result of altered regulation of venous return. Bull NY Acad Med 40: 80Google Scholar
  7. 7.
    Ohnishi K, Saito M, Nakayama T, Iida S, Nomura F, Koen H, Okuda K (1985) Portal venous hemodynamic in chronic liver disease: Effects of posture change and exercise. Radiology 155: 757–761PubMedGoogle Scholar
  8. 8.
    Brown HS, Halliwell M, Qamar R, Read A, Evans JM, Wells PNT (1989) Measurement of normal portal venous blood flow by Doppler ultrasound. Gut 30: 503–509PubMedCrossRefGoogle Scholar
  9. 9.
    Vatner SF, Franklin D, Van Citter RL (1970) Mesenteric vasoactivity associated with eating and digestion in the conscious dog. Am J Physiol 219: 170–174PubMedGoogle Scholar
  10. 10.
    Reininger EJ, Sapirstein LA (1957) Effect of digestion on distribution of blood flow in the rat. Science 126: 1176–1178PubMedCrossRefGoogle Scholar
  11. 11.
    Brandt JL, Castleman L, Ruskin HD, Greenwald JJ, Kelly J (1955) The effect of oral protein and glucose feeding on splanchnic blood flow and oxygen utilization in normal and cirrhotic subjects. J Clin Invest 34: 1017–1025PubMedCrossRefGoogle Scholar
  12. 12.
    Norryd C, Dencker H, Lunderquist A, Olm T, Tylen U (1975) Superior mesenteric blood flow during digestion in man. Acta Chir Scand 141: 197–202PubMedGoogle Scholar
  13. 13.
    Bellamy EA, Bossi MC, Cosgrove DO (1984) Ultrasound demonstration of changes in the normal portal venous system following a meal. Br J Radiol 57: 147–149PubMedCrossRefGoogle Scholar
  14. 14.
    Jaeger K, Bollinger A, Valli C, Ammann R (1986) Measurement of mesenteric blood flow by duplex scanning. J Vasc Surg 3: 462–469CrossRefGoogle Scholar
  15. 15.
    Qamar MI, Read AE (1988) Effects of ingestion of carbohydrate, fat, protein, and water on the mesenteric blood flow in man. Scand J Gastroenterol 23: 26–30PubMedCrossRefGoogle Scholar
  16. 16.
    Moneta GL, Taylor DC, Helton WS, Mulholland MW, Strandness DE (1988) Duplex ultrasound measurement of postprandial intestinal blood flow: effect of meal composition. Gastroenterology 95: 1294–1301PubMedGoogle Scholar
  17. 17.
    Okazaki K, Miyazaki M, Onishi S, Ito K (1986) Effects of food intake and various extrinsic hormones on portal blood flow in patients with liver cirrhosis demonstrated by pulsed Doppler with the Octoson. Scand J Gastroenterol 21: 1029–1038PubMedCrossRefGoogle Scholar
  18. 18.
    Darnault P, Bretagne JF, Raoul JL, Langella B, Gastard J, Duval JM (1987) Effect of food intake on portal blood flow and superior mesenteric venous blood flow in patients with liver cirrhosis demonstrated by pulsed Doppler. In: Bondestam S, Alanen A, Jouppila P (eds) Proceedings of the 6th Congress of the European Federation of Societies for Ultrasound in Medicine and Biology. 14–18 June 1987. Helsinki, Finland, p 70Google Scholar
  19. 19.
    Pugliese D, Ohnishi K, Tsunoda T, Sabba C, Albano O (1987) Portal hemodynamics after meal in normal subjects and in patients with chronic liver disease studied by echo-Doppler flowmeter. Am J Gastroenterol 82: 1052–1056PubMedGoogle Scholar
  20. 20.
    Gaiani S, Bolondi L, LiBassi S, Santi V, Zironi G, Barbara L (1989) Effect of meal on portal hemodynamics in healthy humans and in patients with chronic liver disease Hepatology 9: 815–819PubMedCrossRefGoogle Scholar
  21. 21.
    Benoit JN, Womack WA, Hernandez L, Granger DN (1985) “Forward” and “backward” flow mechanisms of portal hypertension. Relative contributions in the rat model of portal vein stenosis. Gastroenterology 89: 1092–1096Google Scholar
  22. 22.
    Sikuler E, Groszmann RJ (1986) Interaction of flow and resistance in maintenance of portal hypertension in a rat model. Am J Physiol 250: G205–212PubMedGoogle Scholar
  23. 23.
    Groszmann RJ (1987) Pathophysiology of cirrhotic portal hypertension. In: Boyer JL, Bianchi L (eds) Liver cirrhosis. MTP Press, Lancaster, pp 279–292Google Scholar
  24. 24.
    Groszmann RJ, Atterbury CE (1982) The pathophysiology of portal hypertension. Semin Liver Dis 2: 177–186PubMedCrossRefGoogle Scholar
  25. 25.
    Darnault P, Bretagne JF, Raoul JL, Noel J, Siproundhis L, Gastard J (1988) Assessment of the role of portal hypertension and liver failure in lowering splanchnic vascular resistance. Gastroenterology International 1 (Suppl 1): 1017Google Scholar
  26. 26.
    Taylor KJW, Burns PN, Woodcock JP, Wells PNT (1985) Blood flow in deep abdominal and pelvic vessels: ultrasonic pulsed Doppler analysis. Radiology 154: 487–493PubMedGoogle Scholar
  27. 27.
    Huet PM, Goresky CA, Villeneuve JP, Marleau D, Lough JO (1982) Assessment of liver microcirculation in human cirrhosis. J Clin Invest 70: 1234–1244PubMedCrossRefGoogle Scholar
  28. 28.
    Sato S, Ohnishi K, Sugita S, Okuda K (1987) Splenic artery and superior mesenteric artery blood flow: Nonsurgical Doppler US measurement in healthy subjects and patients with chronic liver disease. Radiology 164: 347–352PubMedGoogle Scholar
  29. 29.
    Sabbà C, Ferraioli G, Sarin SK, Groszman RJ, Taylor KJW (1989) Feasibility for Doppler flow measurements in splanchnic vessels in nonselected patient population and in cirrhotics. Gastroenterology 96: A432Google Scholar
  30. 30.
    Jager K, Bollinger A, Valli C, Ammann R (1986) Measurement of mesenteric blood flow by duplex scanning. J Vasc Surg 3: 462–469PubMedCrossRefGoogle Scholar
  31. 31.
    Sieber C, Beglinger C, Jager K, Stalder GA (1989) Regulatory phases of food-induced superior mesenteric artery blood flow (SMABF) in man. Gastroenterology 96: A471Google Scholar
  32. 32.
    Benoit JN, Barrowman JA, Harper SL, Kvietys PR, Granger DN (1984) Role of humoral factors in the intestinal hyperemia associated with chronic portal hypertension. Am J Physiol 247 (Gastrointest Liver Physiol 10): G486–493PubMedGoogle Scholar
  33. 33.
    Sikuler E, Groszmann RJ (1985) Hemodynamic study in a parabiotic model of portal hypertension. Experientia 41: 1323PubMedCrossRefGoogle Scholar
  34. 34.
    Silva G, Chesta J, Bosch J, Mastai R, Navasa M, Kravetz D, Casamitjana R, Rodes J (1987) Effect of glucagon on hepatic and systemic hemodynamics in patients with cirrhosis and portal hypertension. J Hepatol 5 (Suppl 1): S62Google Scholar
  35. 35.
    Karup N, Larsen LA (1974) The effect of glucagon on hepatosplanchnic hemodynamics, functional capacity and metabolism of the liver in cats. Acta Physiol Scand 91: 42–52CrossRefGoogle Scholar
  36. 36.
    Ross G (1970) Regional circulatory effects of pancreatic glucagon. Br J Pharmacol 38: 735–742PubMedCrossRefGoogle Scholar
  37. 37.
    Richardson PDI, Withrington PG (1978) The effects of intraportal infusions of glucagon on the hepatic arterial and portal venous vascular beds of the dog: inhibition of the hepatic arterial vasoconstrictor responses to noradrenaline. Pfluegers Arch 378: 135–140CrossRefGoogle Scholar
  38. 38.
    Sherwin R, Joshi P, Hendler R, Felix P, Conn HO (1974) Hyperglucagonemia in Laennec’s cirrhosis. The role of portal-systemic shunting. N Engl J Med 290: 239–241PubMedCrossRefGoogle Scholar
  39. 39.
    Sherwin R, Fisher M, Bessoff J, Snyder N, Hendler R, Conn HO, Felix P (1976) Hyperglucagonemia in cirrhosis. Altered secretion and sensitivity to glugacon. Gastroenterology 74: 1224–1228Google Scholar
  40. 40.
    Barlin E, Seitz K (1987) Duplex sonography measurement portal venous blood flow and drug-induced flow changes. In: Bondestam S, Alanen A, Jouppila P (eds) Proceedings of the 6th Congress of the European Federation of Societies for Ultrasound in Medicine and Biology. 14–18 June 1987, Helsinki, Finland, p 69Google Scholar
  41. 41.
    Richardson PDI, Withrington PG (1977) The effect of glucagon, secretin, pancreozimin and pentagastrin on the hepatic arterial vascular bed in the dog. Br J Pharmacol 59: 147–156PubMedCrossRefGoogle Scholar
  42. 42.
    Bolondi L, Gaiani S, LiBassi S, Casanova P, Zironi G, Barbara L (1990) Effect of secretin on portal venous flow. Gut 31: 1306–1310PubMedCrossRefGoogle Scholar
  43. 43.
    Post JA, Hanson KM (1975) Hepatic vascular and biliary responses to infusion of gastrointestinal hormones and bile salt. Digestion 12: 65–77PubMedCrossRefGoogle Scholar
  44. 44.
    Bichet DG, Van Putten VJ, Schrier RW (1982) Potential role of increased sympathetic activity of impaired sodium and water excretion in cirrhosis. N Engl J Med 307: 1552–1557PubMedCrossRefGoogle Scholar
  45. 45.
    Cummings SA, Groszmann RJ, Kaumann A (1986) Hypersensitivity of mesenteric veins to 5-hydroxytryptamine and ketanserin-induced reduction of portal pressure in portal hypertensive rats. Br J Pharmacol 89: 501–513PubMedCrossRefGoogle Scholar
  46. 46.
    Moriyasu F, Nishida O, Ban N, Nakamura T, Sakai M, Miyake T, Uchino H (1986) “Congestion index” of the portal vein. AJR 146: 735–739PubMedCrossRefGoogle Scholar
  47. 47.
    Zoli M, Marchesini G, Conliani MR, Pisi P, Brunori A, Trono A, Pisi E (1986) Echo-Doppler measurement of splanchnic blood flow in control and in cirrhotic subjects. JCU 14: 429–435PubMedGoogle Scholar
  48. 48.
    Darnault P, Bretagne JF, Dudicourt JC, Langella B, Gastard J, Duval JM (1987) Effect of umbillical vein recanalization on portal hemodynamics, assessed by echo-Deppler system, in cirrhotic patients. In: Bondestam S, Alanen A, Jouppila P (eds) Proceedings of the 6th Congress of the European Federation of Societies for Ultrasound in Medicine and Biology 14–18 June 1987, Helsinki, Finland p 71Google Scholar
  49. 49.
    Gaiani S, Bolondi L, LiBassi S, Zironi G, Barbara L (1989) Prevalence of reversed flow in the portal venous system in patients with liver cirrhosis and portal hypertension. Gastroenterology 96: A598Google Scholar
  50. 50.
    Ohnishi K, Saito M, Sato S, Nakayama T, Takashi M, Iida S, Nomura F, Koen H, Okuda K (1985) Direction of splenic venous flow assessed by pulsed Doppler flowmetry in patients with a large splenorenal shunt. Gastroenterology 89: 180–185PubMedGoogle Scholar
  51. 51.
    Rector WG, Hoefs JC, Hossack KF, Everson GT (1988) Hepatofugal portal flow in cirrhosis: observations on hepatic hemodynamics and the nature of the arterioportal communications. Hepatology 8: 16–20PubMedCrossRefGoogle Scholar
  52. 52.
    Nakayama T, Hiyama Y, Ohnishi K, Tsushiya S, Kohno K, Nakajima Y, Okuda K (1983) Arterioportal shunts on dynamic computed tomography. AJR 140: 953–957PubMedCrossRefGoogle Scholar
  53. 53.
    Kashiwagi T, Kimura K, Suematsu T, Schichiri M, Kamada T, Abe H (1980) Dynamic studies on portal hemodynamics by scintiphotosplenoportography: Flow pattern of portal circulation. Gut 21: 57–62PubMedCrossRefGoogle Scholar
  54. 54.
    Williams DM, Cho KJ, Aisen AM, Eckhauser FE (1985) Portal hypertension evaluated by MR imaging. Radiology 157: 703–706PubMedGoogle Scholar
  55. 55.
    Gaiani S, Bolondi L, LiBassi S, Zironi G, Siringo S, Barbara L (1991) Prevalence of spontaneous hepatofugal portal flow in liver cirrhosis. Clinical and endoscopic correlation in 228 patients. Gastroenterology 100: 1–8Google Scholar
  56. 56.
    Hunt AH, Whittard BR (1954) Thrombosis of the portal vein in cirrhosis hepatis. Lancet I: 281–284CrossRefGoogle Scholar
  57. 57.
    Okuda K, Ohnishi K, Kimura K, Matsutani S, Sumida M, Goto N, Musha H, Takashi M, Suzuki N, Shinagawa T, Suzuki N, OHtsuki T, Arakawa M, Nakashima T (1985) Incidence of portal vein thrombosis in liver cirrhosis. An angiographic study in 708 patients. Gastroenterology 89: 279–286PubMedGoogle Scholar
  58. 58.
    Burchell AR, Moreno AH, Panke WF, Rousselot LM (1965) Some limitations of splenic portography. I. Incidence, hemodynamic and surgical implications of the nonvisualized portal vein. Ann Surg 162: 981–995PubMedCrossRefGoogle Scholar
  59. 59.
    Bolondi L, Gaiani S, LiBassi S, Zironi G, Santi V, Benzi G, Barbara L (1989) Changes in the hepatic vein waveform detected by Doppler US in liver cirrhosis. J Hepatol 9 (Suppl 1): 117Google Scholar
  60. 60.
    Mostbeck GH, Wittich GR, Herold C, Vergesslich KA, Walter RM, Frotz S, Sommer G (1989) Hemodynamic significance of the paraumbilical vein in portal hypertension: assessment with duplex US. Radiology 170: 339–342PubMedGoogle Scholar
  61. 61.
    Beppu K, Inokuchi K, Koyanagi N, Nakayama S, Sakata H, Kitano S, Kobayashi M (1981) Prediction of variceal hemorrhage by esophageal endoscopy. Gastrointest Endosc 27: 213–218PubMedCrossRefGoogle Scholar
  62. 62.
    Bolondi L, Gaiani S, Zironi G, LiBassi S, Siringo S, Di Febo G, Barbara L (1989) Doppler US flowmetry in patients with liver cirrhosis. Relation to esophageal varices. Hepatology 10: A47Google Scholar
  63. 63.
    Sukigara M, Shimoji K, Komazaki T, Omoto R (1988) An assessment of the correlation between the azygos venous flow volume measured by transesophageal real-time two-dimensional Doppler echography and that measured by continuous thermodilution technique. J Ultrasound Med 1988; 7: S189Google Scholar
  64. 64.
    Sukigara M, Matsumoto T, Yamazaki T, Omoto R (1988) Anatomical and hemodynamic features of the azygos vein, intercostal vein and artery, and esophageal varices. An analysis using transesophageal real-time two-dimensional echography. J Ultrasound Med 7: S189Google Scholar
  65. 65.
    Kimura T, Moryiasu F, Kawasaki T, Someda H, Ono S, Tamada T, Ymahita Y, Kajimura K, Uchino H (1989) Changes in the azygos venous flow evaluated using transesophageal Doppler ultrasound after vasopressin infusion in portal hypertension. Hepatology 10: A42Google Scholar
  66. 66.
    Bolondi L, Gaiani S, LiBassi S, Zironi G, Bonino F, Brunetto M, Barbara L (to be published) Diagnosis of Budd-Chiari syndrome by pulsed Doppler ultrasound. GastroenterologyGoogle Scholar
  67. 67.
    Hosoki T, Kuroda C, Tokunaga K, Marukawa T, Masuike M, Kozuka T (1989) Hepatic venous outflow obstruction: evaluation with pulsed Doppler sonography. Radiology 170: 733–737PubMedGoogle Scholar
  68. 68.
    McMichael J (1932) The portal circulation. 1. The action of adrenaline and posterior pituitary extract. J Physiol (Lond) 75: 241–263Google Scholar
  69. 69.
    Swan KG, Howard MM, Rocko JM, Rush BF Jr, Timmes JJ, Leevy CM (1980) Operative vasopressin and mesocaval shunting for portal hypertension. Surgery 87: 46–51PubMedGoogle Scholar
  70. 70.
    Richardson PDI, Withrington PG (1978) The effect of intraarterial and intraportal injections of vasopressin on the simultaneously perfused hepatic arterial and portal venous vascular beds of the dog. Circ Res 43: 496–503PubMedCrossRefGoogle Scholar
  71. 71.
    Bru C, Bosch J, Navasa M, Bianchi L, Gilambert R, Rodes J (1987) Pulsed-Doppler measurements of portal blood flow in man: Applications in the non-invasive evaluation of pharmacological therapy of portal hypertension. In: Bondestam S, Alanen A, Jouppila P (eds) Proceedings of the 6th Congress of the European Federation of Societies for Ultrasound in Medicine and Biology. 14–18 June 1987. Helsinki, Finland, p 66Google Scholar
  72. 72.
    Lebrec D, Hillon P, Munoz C, Goldfarb G, Nouel O, Benhamou JP (1982) The effect of propranolol on portal hypertension in patients with cirrhosis: a hemodynamic study. Hepatology 2: 523–527PubMedCrossRefGoogle Scholar
  73. 73.
    Cales P, Braillon A, Jiron MI, Lebrec D (1984) Superior portosystemic collateral circulation estimated by azygos blood flow in patients with cirrhosis. Lack of correlation with esophageal varices and gastrointestinal bleeding. Effect of propranolol. J Hepatol 1: 37–46CrossRefGoogle Scholar
  74. 74.
    Hillon P, Lebrec D, Munoz C, Jungers M, Goldfarb G (1982) Comparison of the effects of cardio-selective and a nonselective betablocker on portal hypertension in patients with cirrhosis. Hepatology 2: 528–531PubMedCrossRefGoogle Scholar
  75. 75.
    Zoli M, Marchesini G, Brunori A, Cordiani MR, Pisi E (1986) Portal venous flow in response to acute b-blocker and vasodilatatory treatment in patients wtih liver cirrhosis. Hepatology 6: 1248–1251PubMedCrossRefGoogle Scholar
  76. 76.
    Vorobioff J, Picabea E, Villavicencio R, Puccini V, Rossi O, Bordato S, Audano M (1987) Acute and chronic hemodynamic effects of propranolol in unselected cirrhotic patients. Hepatology 7: 648–653PubMedCrossRefGoogle Scholar
  77. 77.
    Braillon A, Cales P, Valla D, Gaudy D, Geoffroy P, Lebrec D (1986) Influence of the degree of liver failure on systemic and splanchnic hemodynamics and on response to propranolol in patients with cirrhosis. Gut 27: 1204–1209PubMedCrossRefGoogle Scholar
  78. 78.
    Ramond MJ, Comoy E, Lebrec D (1986) Alterations in isoprenaline sensitivity in patients with cirrhosis: evidence of abnormality of the sympathetic nervous activity. Br J Clin Pharmacol 21: 191–196PubMedCrossRefGoogle Scholar
  79. 79.
    Gerbes AL, Remien J, Juengst D, Sauerbruch T, Paumgartner G (1986) Evidence for down-regulation of beta-2-adrenoceptors in cirrhotic patients with severe ascites. Lancet I: 1409–1411CrossRefGoogle Scholar
  80. 80.
    Navasa M, Bosch J, Reichen J, Bru C, Mastai R, Zysset T, Silva G, Chesta J, Ródes J (1988) Effects of verapamil on hepatic and systemic hemodynamics and liver function in patients with cirrhosis and portal hypertension. Hepatology 8: 850–854PubMedCrossRefGoogle Scholar
  81. 81.
    Bernardino ME, Steinberg HV, Pearson TC, Gedgaudas-McClees RK, Torres WE, Henderson JM (1986) Shunts for portal hypertension: MR and angiography for determination of patency. Radiology 158: 57–61PubMedGoogle Scholar
  82. 82.
    Gleysteen JJ, Foley WD, Lawson TL, Unger GF (1982) Patency evaluation of distal spleno-renal shunt with dynamic computed tomography. Surg Gynecol Obstet 154: 689–694PubMedGoogle Scholar
  83. 83.
    Goldberg BB, Patel J (1977) Ultrasonic evaluation of portacaval shunts. JCU 5: 304–306PubMedGoogle Scholar
  84. 84.
    Bolondi L, Mazziotti A, Arienti V, Casanova P, Gasbarrini G, Cavallari A, Bellusci R, Gozzetti G, Labò G (1984) Ultrasonographic study of the portal venous system in portal hypertension and after porto-systemic shunt operation. Surgery 95: 261–269PubMedGoogle Scholar
  85. 85.
    Forsberg L, Holmin R (1983) Pulsed Doppler and B-mode ultrasound features of interposition meso-caval and porta-caval shunts. Acta Radiol [Diagn] (Stockh) 24: 257–353Google Scholar
  86. 86.
    Ackroyd N, Gill R, Griffiths K, Kossoff G, Reeve T (1986) Duplex scanning of the portal vein and portasystemic shunts. Surgery 99: 591–597PubMedGoogle Scholar
  87. 87.
    Lafortune M, Patriquin H, Pomier G, Huet PM, Weber A, Lavoie P, Blanchard H, Breton G (1987) Hemodynamic changes in portal circulation after portosystemic shunts: Use of duplex sonography in 43 patients. AJR 149: 701–706PubMedCrossRefGoogle Scholar
  88. 88.
    Moriyasu F, Nishida O, Ban N, Nakamura T, Tamada T, Kawasaki T, Sakai M, Miyake T, Kumada K, Ozawa K, Uchino H (1987) Ultrasonic Doppler duplex study of hemodynamic changes from portosystemic shunt operation. Ann Surg 205: 151–156PubMedCrossRefGoogle Scholar
  89. 89.
    Bolondi L, Gaiani S, Mazziotti A, Casanova P, Cavallari A, Gozzetti G, Barbara L (1988) Morphological and hemodynamic changes in the portal venous system after distal spleno-renal shunt: an ultrasound and pulsed Doppler study. Hepatology 8: 652–657PubMedCrossRefGoogle Scholar
  90. 90.
    Tylen U, Simert G, Vang J (1986) Hemodynamic changes after distal spleno-renal shunt studied by sequential angiography. Radiology 121: 585–589Google Scholar
  91. 91.
    Flint EW, Sumkin JH, Zajko AB, Bowen AD (1988) Duplex sonography of hepatic artery thrombosis after liver transplantation. AJR 151: 481–483PubMedCrossRefGoogle Scholar
  92. 92.
    Longley DG, Skolnick ML, Sheahan DG (1988) Acute allograft rejection in liver transplants recipients: Lack of correlation with hepatic artery diastolic flow. Radiology 169: 417–420PubMedGoogle Scholar
  93. 93.
    Taylor KJW, Morse SS, Weltin GG, Riely CA, Flye MW (1986) Liver transplants recipients: portable duplex US with correlative angiography. Radiology 159: 357–363PubMedGoogle Scholar
  94. 94.
    Longley DG, Skolnick ML, Zajko AB, Bron KM (1988) Duplex sonography in the evaluation of adult patients before and after liver transplantation. AJR 151: 687–696PubMedCrossRefGoogle Scholar
  95. 95.
    Barbara L, Bolondi L, Gaiani S, Zironi G, Mazziotti A, LiBassi S, Sama C, Gozzetti G (1990) Assessment of vascular patency in liver transplant by Doppler ultrasound. In: Dianzani MU, Gentilini P (eds) Chronic liver damage. Elsevier, Amsterdam, p 295-309Google Scholar

Copyright information

© Springer Japan 1991

Authors and Affiliations

  • Luigi Bolondi
  • Stefano Gaiani
  • Luigi Barbara
    • 1
  1. 1.Istituto di Clinica Medica e GastroenterologiaUniversità di BolognaBolognaItaly

Personalised recommendations