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[Spontaneous reversal of portal flow in cirrhosis. Angiographic study of 15 cases (author's transl)].

Spontaneous reversal of intra-hepatic portal flow in cirrhoses appears to be best demonstrated by arteriography, which shows a direct sign, i.e. retrograde opacification of intra-hepatic portal branches during selective hepate arteriography, and an indirect sign, i.e. the appearance of functional amputation of these same portal branches at the time of superior mesenteric venous return. Reversal of portal flow is sometimes complete (5 out of 15 cases), the flow being entirely away from the liver and sometimes incomplete (10 out of 15 cases), limited to the interior of the liver, portal flow then being bidirectional. Reflux of arterial blood in the intra-hepatic portal branches via the development of intra-hepatic arterioportal communications appears to be the determining factor in the reversal of portal flow in cirrhosis. The degree of portal flow away from the liver seems to depend essentially upon the extent of development of porto-caval anastomoses. Certain features suggest that there is a relationship between the development of the hepatic arterial circulation and that of the porto-caval anastomoses. These two elements which determine the degree of portl hypertension may mutually influence each other. This hypothesis is interesting in the context of understanding the haemodynamic abnormalities of advanced cirrhosis.