[Splenoportography; lack of correlation between in vivo & post mortem splenoportography; false image of portal obstruction caused by currents of nonopacified blood].
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Angiography↗
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[Transparietal splenoportography (TSP). Experience on 50 splenoportographies with operative verification of the diagnosis].
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Angiography↗
[Value of splenoportography in the diagnosis of esophago-gastric varices. (Comparative study by endoscopy, esophagogram and splenoportography)].
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Angiography↗
Comparison of splenoportography and transhepatic portography in the diagnosis of portal vein thrombosis.
Accurate diagnosis and localization of thrombosis in the portal venous system is essential for proper surgical treatment. We compared the results of percutaneous transhepatic portography and splenoportography in 66 patients with cirrhosis of the liver. The two methods agreed on absence of thrombosis in 48, and in presence of thrombosis (verified later by surgery/autopsy) in four patients. In 12 patients an apparent thrombosis diagnosed by splenoportography was disproved by transhepatic portography, and vice versa in two patients. Free portal pressure and splenic pulp pressure did not differ significantly irrespective of the 'diagnosis' of thrombosis. We conclude, that transhepatic portography is better than splenoportography in making the diagnosis of thrombosis in the portal venous system although failure to visualize the splenic vein may indicate splenoportography.
Female↗
[Indirect (arterial) splenoportography and portography in intraphepatic block].
Morphology and flow dynamics in the lieno-mesentericoportal territory were investigated in 15 normal persons and 199 patients with pre/intra and intra-hepatic blocks. Indirect (arterial) splenoportography with selective catherization of the splenic artery provided angiograms varying between good and diagnostically useful in 98% of cases. With injection into the truncus coeliacus, this figure falls to 77%. The various types of collateral circulation are stated and discussed. The scope and limits of the methods are shown by comparative surveys between direct splenoportography and indirect splenoportography and portography, using 16 patients. As far as the chronological sequence of angiographical diagnostics in the intrahepatic block is concerned, the indirect method shall precede direct splenoportography, which shall only be employed if the indirect method of examination does not provide sufficient information, the patient has shunt capacity and an operation is to be performed immediately.
Adult↗
[Splenoportography in pancreatic tumors and retroperitoneal neoplasms].
Along with other methods of investigation splenoportography was performed in 29 patients with tumors and in 2 patients with cystic affection of the pancreas. Moreover, in 5 cases splenoportography was performed due to a suspicion to pancreatic tumor, and also in 6 patients with retroperitoneal tumors and in 7-with renal tumors. In all these patients with pancreatic tumors splenoportograms have shown changes on the part of a splenoportal trunk, which corresponded to the localization and degree of spread of a tumor in most cases. Splenoportography is felt to be rational in retroperitoneal tumors. In such cases splenoportography would contribute to a detailed determination of tumor localization and its relation with the liver.
Adult↗
[Hemodynamic disorders resulting from angiography (selective arteriography of the celiac trunk and splenoportography) (author's transl)].
The hemodynamic disorders resulting from the selective arteriography of celiac trunk and splenoportography were studied in 30 dogs. The systemic blood pressure and peripheral pulse rate were considered in these instants: before, during, immediately after and 10 minutes after the angiographic procedures. The analysis of the results obtained permit to conclude that: a) catheterism of the celiac trunk only, increase the systolic systemic blood pressure but does not change the dyastolic; b) during the injection of the contrast medium in the celiac trunk there is an increase of the systemic blood pressure (systolic and dyastolic); c) the selective arteriography of the celiac trunk as well as the splenoportography cause decrease of the systemic blood pressure (systolic and dyastolic) immediately after (1 to 70 seconds) the procedure; d) the decrease of the systemic blood pressure (systolic and dyastolic) is greater after the arteriography than after the splenoportography; e) the decrease of the systemic blood pressure (systolic and dyastolic) is transitory; 10 minutes after the realization of angiographies the systemic blood pressure return to the values observed before the examination; f) selective arteriography of the celiac trunk as well as splenoportography cause decrease of the peripheral pulse rate 10 minutes after the realization of the angiographic procedures.
Angiography↗
Splenopneumopexy: evaluation with splenoportography.
Splenopneumopexy is a procedure designed to create a portopulmonary shunt in patients with esophageal variceal bleeding who are not candidates for conventional portosystemic shunts. Splenoportography was performed in three patients who underwent this surgical procedure. Portopulmonary shunts were identified in two of three patients. No complications resulted from splenoportography. Splenoportography is the procedure of choice to identify portopulmonary shunts in splenopneumopexy patients who have undergone splenic artery embolization.
Adult↗
Improved safety of splenoportography by plugging of the needle tract.
Splenoportography, a useful preoperative diagnostic procedure in patients with portal hypertension, has been largely discontinued because of the risk of hemorrhage. We have used both Ivalon and Gelfoam in particle and plug form to plug the needle tract after splenoportography. Initial studies were conducted on six dogs. Plugging of the needle tract by injection of suspensions of small Gelfoam or Ivalon particles resulted in intravasation of these particles into the splenic vein. This was demonstrated by radioactive tagging of particles and the direct collection of splenic blood during the intrasplenic injection. Plugging of the splenic needle tract with compressed Gelfoam caused immediate, complete cessation of bleeding in fully heparinized animals. Because of these experimental results, five humans with decreased platelet counts and severe portal hypertension underwent successful splenoportography without significant hemorrhage. At surgery, successful plugging of the needle tract by Gelfoam was confirmed.
Adult↗
CO2 splenoportography: preliminary results.
OBJECTIVE: Previously, splenoportography with 18-gauge needles provided excellent portal imaging. However, because of concern about bleeding, this technique was replaced with arterial portography and noninvasive techniques, which are not always accurate. We present a modification of splenoportography using CO2 and an ultrafine needle in eight patients whose previous imaging studies were inconclusive. CONCLUSION: CO2 splenoportography is safe and expedient and provides adequate visualization of the portal system for surgical planning in selected patients.
Adolescent↗
CO2 digital subtraction splenoportography with the "skinny" needle: experimental study in a swine model.
PURPOSE: To evaluate the safety and the effectiveness of CO2 splenoportography with the "skinny" needle. METHODS: A flexible, 22 gauge needle ("skinny" needle) was introduced into the exteriorized spleens of five pigs. After checking the intrasplenic positioning with CO2 injection, increasing doses of CO2 (10-60 cm3) were injected using a dedicated CO2 injector with digital imaging. The puncture sites were observed during and after CO2 injections, and after removal of the needle. The spleens were then removed for gross and microscopic examination. RESULTS: In all animals digital subtraction CO2 splenoportograms showed the splenic, extra- and intrahepatic portal veins, and the most distal portion of the superior mesenteric vein. No CO2 extravasation occurred in the spleen. There was no significant bleeding from the puncture site after removal of the needle. Gross and microscopic examination revealed no evidence of splenic rupture or intrasplenic hematoma. CONCLUSION: CO2 splenoportography with the "skinny" needle is a safe and simple method of visualizing the portal vein and its branches. Careful appraisals of the clinical usefulness of the method will be needed in various clinical settings.
Angiography, Digital Subtraction↗
Splenoportography in the pediatric age group.
Eleven splenoportograms were performed in 10 patients between the ages of 2.5 and 17 yr. A definitive diagnosis was made in every instance. There were no complications despite the fact that 6 patients had platelet counts less than 100,000/mm3. Fear of potential complications is unwarranted, and splenoportography should be an essential part of the workup of a child suspected of having portal hypertension. Splenoportography, when combined with measurement of splenic pulp pressure, provides precise information regarding the presence of and/or change in portal hypertension and its underlying cause. With this information, therapy for the pediatric patient with portal hypertension can be individualized and managed in a logical fashion.
Adolescent↗
Splenoportography--a valuable diagnostic technic, revisited.
The value of splenoportography in evaluating patients with portal hypertension was assessed. The technic was found to be useful in estimating portal-venous pressure, ruling out portal vein thrombosis, evaluating the superior mesenteric and portal veins as to their suitability for shunt procedures, and defining anatomy and collateral pathways. Splenoportography is a relatively simple procedure which provides excellent visualization of the portal venous system. Other methods may require special expertise and may not yield sufficient diagnostic information.
Collateral Circulation↗
Safe splenoportography.
The records of 37 patients who had undergone splenoportography, including one group of 12 who were studied before 1976 and a second group of 25 who were studied after 1977, were reviewed. The primary difference was that in the second group, the tract in the spleen was occluded with absorbable gelatin sponge (Gelfoam) plugs as the needle was withdrawn. In addition, there were minor changes in technique, such as changes in the needle puncture angle and entry site. When the new technique was used, there was a significant decrease in the complications traditionally associated with splenoportography. This procedure is safe and deserves to be considered the procedure of choice in patients in whom precise anatomic information is needed preoperatively that cannot be obtained with noninvasive procedures such as ultrasound or magnetic resonance imaging.
Adolescent↗
[Accidents and complications of splenoportography].
The literature concerning accidents and complications of transcutaneous splenoportography is examined and compared with personal experience. The technique used is discussed and some of its advantages with respect to selective arteriography of the coeliac tripod are stressed. It is concluded transcutaneous that splenoportography is free from any particular risk and has no equal in the detailed study of certain alterations of the splenoportal trunk.
Adult↗
[Comparison of echo-Doppler and splenoportography in the hemodynamic evaluation of the portal system].
The Authors discuss the instrumental diagnosis of portal hypertension, comparing echo-Doppler and splenoportography by celiac artery catheterization, performed on 42 patients with cirrhosis. From the data obtained, there may be observed a clear correlation between angiographic and echographic criteria, correlated to the degree of illness. In particular echo-Doppler whether it possible, in a non-invasive way, to control the evolution of progressive haemodynamic resistance, and hepatic and splenic parenchyma, leaving to splenoportography the role to depict anatomic characteristics of portal circulation for a correct surgical program.
Adult↗
[Clinical study of radioisotopic splenoportography in portal hypertension].
Radioisotopic splenoportography was performed in 55 patients with portal hypertension, in whom 52 had various degrees of esophagogastric varices, and in 20 patients without portal hypertension. In the patients with varices, collateral images were obtained in 50 patients (96%) by this method and no image was obtained in the patients without varices. The rate of positively imaged collaterals was as follows: Esophageal varices 69%, the left gastric vein 85%, the short gastric veins 48%, RI stasis in esophagogastric region 65%, the azygos vein 46%, the subclavian vein 25%, the para-umbilical veins 46%, splenorenal /gastrorenal shunts 19%, the inferior mesenteric vein 17%, the left intercostal veins 6%, and Arantius's duct 4%. These rates were superior to that obtained from the conventional transarterial portography. There were some correlations between RI-images by this method and clinical and laboratory findings; patients with ascending collaterals alone tended to have extensive and severe varices and higher rate of bleeding, on the other hand, variceal bleeding was not found and episodes of portosystemic encephalopathy frequently occurred in patients with descending collaterals alone. After successful sclerotherapy, RI-images of esophageal varices disappeared in 92% of the patients. Radioisotopic splenoportography appears to be a useful diagnostic and follow-up modality for patients with portal hypertension and esophagogastric varices.
Collateral Circulation↗
Ultrasonography in non-cirrhotic portal hypertension: correlation with splenoportography.
Real time sonography followed by splenoportography was performed in 38 cases with non-cirrhotic portal hypertension. Eleven of these cases, in whom porto-systemic shunt surgery was done, were also evaluated by real time sonography post-operatively. The ultrasound findings correlated well in 37 cases (98%) with splenoportography. All the post-operative cases also revealed a patent portosystemic shunt on sonography. Ultrasonography, a valuable, non-invasive, initial investigation of portal hypertension, may thus be used as the only investigation to distinguish intra- from extra-hepatic obstruction and to evaluate patency of surgically created porto-systemic shunts. Invasive portography may be performed only if surgical treatment is anticipated.
Adolescent↗