TY - JOUR
T1 - Effects of transjugular intrahepatic portosystemic shunt (TIPS) on blood volume distribution in patients with cirrhosis
AU - Busk, Troels M
AU - Bendtsen, Flemming
AU - Henriksen, Jens H
AU - Fuglsang, Stefan
AU - Clemmesen, Jens O
AU - Larsen, Fin S
AU - Møller, Søren
N1 - Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
PY - 2017/12
Y1 - 2017/12
N2 - Background Cirrhosis is accompanied by portal hypertension with splanchnic and systemic arterial vasodilation, and central hypovolaemia. A transjugular intrahepatic portosystemic shunt (TIPS) alleviates portal hypertension, but also causes major haemodynamic changes. Aims To investigate effects of TIPS on regional blood volume distribution, and systemic haemodynamics. Methods Thirteen cirrhotic patients had their regional blood volume distribution determined with gamma-camera technique before and after TIPS. Additionally, we measured systemic haemodynamics during liver vein and right heart catheterization. Central and arterial blood volume (CBV) and cardiac output (CO) were determined with indicator dilution technique. Results After TIPS, the thoracic blood volume increased (+10.4% of total blood volume (TBV), p < 0.01), whereas the splanchnic blood volume decreased (−11.9% of TBV, p < 0.001). CO increased (+22%, p < 0.0001), and systemic vascular resistance decreased (−26%, p < 0.001), whereas CBV did not change. Finally, right atrial pressure and mean pulmonary artery pressure increased after TIPS (+50%, p < 0.005; +40%, p < 0.05, respectively). Conclusions TIPS restores central hypovolaemia by an increase in thoracic blood volume and alleviates splanchnic vascular congestion. In contrast, CBV seems unaltered. The improvement in central hypovolaemia is therefore based on an increase in thoracic blood volume that includes both the central venous and arterial blood volume. This is supported by an increase in preload, combined with a decrease in afterload.
AB - Background Cirrhosis is accompanied by portal hypertension with splanchnic and systemic arterial vasodilation, and central hypovolaemia. A transjugular intrahepatic portosystemic shunt (TIPS) alleviates portal hypertension, but also causes major haemodynamic changes. Aims To investigate effects of TIPS on regional blood volume distribution, and systemic haemodynamics. Methods Thirteen cirrhotic patients had their regional blood volume distribution determined with gamma-camera technique before and after TIPS. Additionally, we measured systemic haemodynamics during liver vein and right heart catheterization. Central and arterial blood volume (CBV) and cardiac output (CO) were determined with indicator dilution technique. Results After TIPS, the thoracic blood volume increased (+10.4% of total blood volume (TBV), p < 0.01), whereas the splanchnic blood volume decreased (−11.9% of TBV, p < 0.001). CO increased (+22%, p < 0.0001), and systemic vascular resistance decreased (−26%, p < 0.001), whereas CBV did not change. Finally, right atrial pressure and mean pulmonary artery pressure increased after TIPS (+50%, p < 0.005; +40%, p < 0.05, respectively). Conclusions TIPS restores central hypovolaemia by an increase in thoracic blood volume and alleviates splanchnic vascular congestion. In contrast, CBV seems unaltered. The improvement in central hypovolaemia is therefore based on an increase in thoracic blood volume that includes both the central venous and arterial blood volume. This is supported by an increase in preload, combined with a decrease in afterload.
KW - Journal Article
U2 - 10.1016/j.dld.2017.06.011
DO - 10.1016/j.dld.2017.06.011
M3 - Journal article
C2 - 28729141
SN - 1590-8658
VL - 49
SP - 1353
EP - 1359
JO - Digestive and Liver Disease
JF - Digestive and Liver Disease
IS - 12
ER -