Hemodynamic changes in the hepatic circulation after the modulation of the splenic circulation in an in vivo human experimental model

Authors

  • Nobuhisa Akamatsu,

    1. Department of Hepatobiliary-Pancreatic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
    2. Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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  • Yasuhiko Sugawara,

    Corresponding author
    1. Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
    • Address reprint requests to Yasuhiko Sugawara, M.D., Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan. Telephone: 81-3-3815-5411; FAX: 81-3-5684-3989; E-mail: yasusuga-tky@umin.ac.jp

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  • Shouichi Satou,

    1. Department of Hepatobiliary-Pancreatic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
    2. Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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  • Tetsuya Mitsui,

    1. Department of Hepatobiliary-Pancreatic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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  • Riki Ninomiya,

    1. Department of Hepatobiliary-Pancreatic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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  • Masahiko Komagome,

    1. Department of Hepatobiliary-Pancreatic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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  • Fumiaki Ozawa,

    1. Department of Hepatobiliary-Pancreatic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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  • Yoshifumi Beck

    1. Department of Hepatobiliary-Pancreatic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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  • This study was supported by a Grant-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan.

  • The authors have no conflicts of interest to disclose.

Abstract

Recent advances in liver surgery have highlighted the effects of the splenic circulation on the hepatic circulation with respect to the hepatic arterial buffer response (HABR). The aim of the present study was to investigate the actual hemodynamic effects of splenic artery embolization/ligation and splenectomy on the hepatic circulation in patients who underwent pancreaticoduodenectomy through in vivo experimental models. In vivo models of splenic artery embolization/ligation (only splenic artery clamping) and splenectomy (simultaneous clamping of both the splenic artery and the splenic vein) were created in 40 patients who underwent pancreaticoduodenectomy for various reasons. The portal venous flow velocity, the portal venous flow volume, the hepatic arterial flow velocity, and the hepatic arterial resistance index were measured with color Doppler ultrasonography. Clamping of the splenic artery induced an immediate and significant increase (16%) in the hepatic artery velocity (P < 0.001), and the portal venous flow also decreased significantly (10%, P = 0.03). Fifteen minutes after the clamping of the splenic artery, the hepatic artery velocity remained significantly increased at the level of the initial clamping, and the portal venous flow significantly decreased (16%, P < 0.001). Clamping of the splenic vein, which was performed after the clamping of the splenic artery, resulted in an immediate and significant decrease (30%) in the portal venous flow (P < 0.001), but the hepatic arterial flow was not affected. Fifteen minutes after the clamping of the splenic vein, there was no change in the portal flow, which remained significantly lower (28%) than the flow in controls, whereas the hepatic arterial flow further significantly increased (31%, P < 0.001). In conclusion, our findings indicate that both splenic artery embolization/ligation and splenectomy are effective for increasing hepatic arterial flow and decreasing portal flow, with splenectomy providing a greater advantage. The HABR underlies these hemodynamic changes. Liver Transpl 20:116–121, 2014. © 2013 AASLD.

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