Splenic Artery Ligation and Portocaval Shunt in Small-for-size Syndrome

NCT ID: NCT05459883

Last Updated: 2022-07-15

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 13 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2017-01-01
• Study Completion Date: 2021-12-31

Brief Summary

Our study aimed at assessing the changes of portal vein pressure, portal vein flow and hepatic arterial flow (HAF) in liver remnants ≤ 30% of the standard liver volume by reducing portal vein overflow via ligation of the splenic artery.

Detailed Description

It has been reported that prevention of acute portal overpressure in small-for-size liver grafts leads to better postoperative outcomes. Accordingly, we aimed to investigate the feasibility of the technique of splenic artery ligation in a case series of patients subjected to major liver resections with evidence of small-for-size syndrome and whether the maneuver results in reduction of portal venous pressure and flow.

Conditions

Small-For-Size Liver Syndrome; Ligation; Liver Regeneration; Splenic Artery; Portal Vein; Ischemia; Reperfusion Injury; Hepatectomy

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: RETROSPECTIVE

Interventions

splenic artery ligation

We identified portal hyperperfusion as a cause of potential small-for-size liver remnant dysfunction and we applied splenic artery ligation as a technically simple procedure to manage the situation

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• Adult patients
• American Society of Anesthesiologists (ASA) distribution I to III
• Patients scheduled for major liver resection (≥4 segments)

Exclusion Criteria

• patients with extrahepatic disease
• patients with metastatic liver tumors

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 75 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Aretaieion University Hospital

OTHER

Sponsor Role: lead

Responsible Party

Dr Kassiani Theodoraki

Professor of Anesthesiology

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Kassiani Theodoraki

Role: PRINCIPAL_INVESTIGATOR

Aretaieion University Hospital, Athens, Greece

Locations

Aretaieion University Hospital

Athens, Attica, Greece

Countries

Greece

References

Theodoraki K, Arkadopoulos N, Nastos C, Vassiliou I, Karmaniolou I, Smyrniotis V. Small liver remnants are more vulnerable to ischemia/reperfusion injury after extended hepatectomies: a case-control study. World J Surg. 2012 Dec;36(12):2895-900. doi: 10.1007/s00268-012-1779-6.

Reference Type: BACKGROUND

PMID: 22956015 (View on PubMed)

Garcia-Valdecasas JC, Fuster J, Charco R, Bombuy E, Fondevila C, Ferrer J, Ayuso C, Taura P. Changes in portal vein flow after adult living-donor liver transplantation: does it influence postoperative liver function? Liver Transpl. 2003 Jun;9(6):564-9. doi: 10.1053/jlts.2003.50069.

Reference Type: BACKGROUND

PMID: 12783396 (View on PubMed)

Kinaci E, Kayaalp C. Portosystemic Shunts for "Too Small-for-Size Syndrome" After Liver Transplantation: A Systematic Review. World J Surg. 2016 Aug;40(8):1932-40. doi: 10.1007/s00268-016-3518-x.

Reference Type: BACKGROUND

PMID: 27160453 (View on PubMed)

Lo CM, Liu CL, Fan ST. Portal hyperperfusion injury as the cause of primary nonfunction in a small-for-size liver graft-successful treatment with splenic artery ligation. Liver Transpl. 2003 Jun;9(6):626-8. doi: 10.1053/jlts.2003.50081.

Reference Type: BACKGROUND

PMID: 12783407 (View on PubMed)

Umeda Y, Yagi T, Sadamori H, Matsukawa H, Matsuda H, Shinoura S, Mizuno K, Yoshida R, Iwamoto T, Satoh D, Tanaka N. Effects of prophylactic splenic artery modulation on portal overperfusion and liver regeneration in small-for-size graft. Transplantation. 2008 Sep 15;86(5):673-80. doi: 10.1097/TP.0b013e318181e02d.

Reference Type: BACKGROUND

PMID: 18791439 (View on PubMed)

Other Identifiers

418/18-04-2022

Identifier Type: -

Identifier Source: org_study_id