Evolution of Thoracic Duct Congestion after Portal Decompression by TIPS in Cirrhotic Patients.
Cirrhosis
Liver lymphatic drainage
Portal hypertension
TIPS
Thoracic duct
Journal
Cardiovascular and interventional radiology
ISSN: 1432-086X
Titre abrégé: Cardiovasc Intervent Radiol
Pays: United States
ID NLM: 8003538
Informations de publication
Date de publication:
Oct 2022
Oct 2022
Historique:
received:
04
04
2022
accepted:
28
07
2022
pubmed:
10
8
2022
medline:
28
9
2022
entrez:
9
8
2022
Statut:
ppublish
Résumé
To evaluate the thoracic duct (TD) diameter on CT scan in a population of cirrhotic patients before and after relief of portal hypertension by transjugular intrahepatic portosystemic shunt (TIPS) insertion. To evaluate the association between the initial TD diameters and the cirrhosis severity, the morphological signs of portal hypertension and the clinical success of TIPS. This retrospective monocentric study included 54 cirrhotic patients who underwent TIPS insertion between 2010 and 2020. Measurements of the TD were performed in CT scan at two distinct points: at the cisterna chyli (CC) and at the terminal TD near the lymphovenous junction. The mean diameter of the TD was 6.4 mm (± 2.9) at the CC and 6.9 mm (± 1.9) near the lymphovenous junction. After TIPS, the mean diameter decreased to 5.1 (± 2.1) at the CC (p < 0.001) and to 4.3 (± 1.5) at the terminal TD (p = 0.001). The initial TD diameter was associated with the presence of voluminous venous collaterals (p = 0.04 at CC and p = 0.04 junction). The initial terminal TD diameter was weakly associated with the largest axis of the spleen (r = 0.126, p = 0.03) and moderately associated with the azygos vein diameter (r = 0.511, p = 0.001). Initial TD diameter was not associated with Child-Pugh score (r = 0.276, p = 0.08 and r = 0.169, p = 0.7) or with clinical success of TIPS on ascites (p = 0.33 and 0.60) or on bleeding (p = 0.13 and 0.99). The diameter of the TD decreases after TIPS, but its initial diameter does not seem to be predictive of the clinical success of TIPS.
Identifiants
pubmed: 35945351
doi: 10.1007/s00270-022-03243-7
pii: 10.1007/s00270-022-03243-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1534-1539Informations de copyright
© 2022. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).
Références
Ohtani O, Ohtani Y. Lymph circulation in the liver. Anat Rec (Hoboken). 2008;291:643–52.
doi: 10.1002/ar.20681
Johnson O, Chick J, Chauhan N, Fairchild A, Fan C, Stecker M, et al. The thoracic duct: clinical importance, anatomic variation, imaging, and embolization. Eur Radiol. 2016;26:2482–93.
doi: 10.1007/s00330-015-4112-6
Witte M, Witte C, Cole W, Koehler P. Contrasting patterns of ascites formation in hepatic cirrhosis. JAMA. 1969;208:1661–6.
doi: 10.1001/jama.1969.03160090021005
Witte M, Dumont A, Cole W, Witte C, Kintner K. Lymph circulation in hepatic cirrhosis: effect of portacaval shunt. Ann Intern Med. 1969;70:303–10.
doi: 10.7326/0003-4819-70-2-303
Zironi G, Cavalli G, Casali A, Piscaglia F, Gaiani S, Siringo S, et al. Sonographic assessment of the distal end of the thoracic duct in healthy volunteers and in patients with portal hypertension. AJR Am J Roentgenol. 1995;165(4):863–6.
doi: 10.2214/ajr.165.4.7676982
Hwang S, Oh Y, Ham S, Kang E, Lee K, Yong H. Evaluation of the left neck distal thoracic duct in cirrhosis with computed tomography. Clin Imaging. 2016;40:465–9.
doi: 10.1016/j.clinimag.2016.01.005
Park S, Kim T, Ham S, Um S, Goh H, Lee S, et al. Clinical implications of thoracic duct dilatation in patients with chronic liver disease. Medicine. 2020;99(22):e19889.
doi: 10.1097/MD.0000000000019889
Parasher VK, Meroni E, Malesci A, Spinelli P, Tommasini MA, Markert R, et al. Observation of thoracic duct morphology in portal hypertension by endoscopic ultrasound. Gastrointest Endosc. 1998;48(6):588–92.
doi: 10.1016/S0016-5107(98)70040-9
Ghelfi J, Brusset B, Thony F, Decaens T. Successful management of refractory ascites in non-TIPSable patients using percutaneous thoracic duct stenting. J Hepatol. 2021;76(1):216–8.
doi: 10.1016/j.jhep.2021.06.033
Strunk H, Marinova M. Transjugular intrahepatic portosystemic shunt (TIPS): pathophysiologic basics, actual indications and results with review of the literature. RoFo. 2018;190:701–11.
doi: 10.1055/a-0628-7347
Vizzutti F, Schepis F, Arena U, Fanelli F, Gitto S, Aspite S, et al. Transjugular intrahepatic portosystemic shunt (TIPS): current indications and strategies to improve the outcomes. Intern Emerg Med. 2020;15:37–48.
doi: 10.1007/s11739-019-02252-8
Pieper C, Feißt A, Meyer C, Luetkens J, Praktiknjo M, Trebicka J, et al. Impact of transjugular intrahepatic portosystemic shunt creation on the central lymphatic system in liver cirrhosis. Sci Rep. 2021;11(1):7065.
doi: 10.1038/s41598-021-86006-7