Features of Angioarchitectonics and Hemodynamics in the System of the Portal Vein in Patients with Cirrhosis of the Liver with Portal Hypertension

Relevance In surgery of portal hypertension (PH), special importance is attached to the variants of anatomy of the vessels of splenoportal and left renal pools which have fundamental importance in terms of the possibility of imposing different types of shunt operations. The purpose of the study To study features of angioarchitectonics and hemodynamics in the system of portal vein in patients with liver cirrhosis (LC) with portal hypertension. Materials and methods For identifying features of changes of angioarchitectonics of portal pool in the conditions of progressive PH were examined 254 patients with liver cirrhosis, which from 2007 to 2013 were performed different variants of the vascular portosystemic shunt. All patients were divided into three age groups: under 30 years; 31-49 years and older than 50 years. Results and their discussion In the older age group, the development and progression of PH does not lead to a significant increasing the size of the spleen. Conversely, in the group of 30 years spleen size had a tendency to form splenomegaly 2-3 degrees. Facticaly in equivalent level of portal pressure, diameters of v.portae and v.lienalis had significant difference. In the group of under 30 years portal vein diameter was 1,45 ± 0,03 cm in the group 31-49 years - 1,37 ± 0,02 cm, and in the group older than 50 years was the lowest diameter - 1,30 ± 0, 03 cm, and splenic 1,05 ± 0,04 cm. In comparing the diameter of the splenic vein in all of the parameter to receives significant difference with the formation of a minimum diameter - 1,05 ± 0,04 cm in patients older than 50 years. Conclusion Compensation of progressive PH due to expansion of the vascular channel of splenoportal pool is most common in patients with liver cirrhosis under 30 years, which proves maximum angiotransformation with a significant relative to the other age groups increasing of diameter of v.portae and v.lienalis, severity of splenomegaly and a lower incidence of variceal bleeding carried over. Conducted morphological studies have shown that in the conditions of liver cirrhosis with portal hypertension, the structure of the walls of veins of portolienal pool undergoes substantial changes, severity of which depends on the age of the patients and for patients older than 50 years is characterized by a more pronounced thickening of membranes, especially t. media and t. adventitia, and for patients under 30 years - increasing the lumen of the veins

Liver cirrhosis, portal hypertension, portosystemic shunt