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Comparison of portal venous flow in cirrhotic patients with and without paraumbilical vein patency using duplex-sonography.

AIM
In a prospective study we examined the effect of paraumbilical vein patency on the portal venous blood flow in patients with liver cirrhosis by Duplex-sonography. In this context we investigated the influence of the aetiology and the severity of cirrhosis on the development of venous paraumbilical shunts.


METHOD
In 70 patients (Child A: 16; Child B: 27; Child C: 27) with cirrhosis of different aetiologies the portal venous flow velocity, the blood flow volume, and the diameter of the portal vein were examined by Duplex sonography after an overnight fast.


RESULTS
16 patients had a patent paraumbilical vein. The mean portal venous flow velocity (19.2 +/- 7.8 cm/s) and the flow volume (1.29 +/- 0.50 l/min) were significantly higher in patients with paraumbilical vein patency than in patients without paraumbilical shunts (14.4 +/- 4.6 cm/s; p = 0.029 and 0.88 +/- 0.34 l/min; p = 0.007 respectively). The prevalence of shunts of the paraumbilical vein in cirrhotics was significantly lower in category Child A (6.3%) than in Child B (25.9%; p = 0.011) and Child C (33.3%; p = 0.006).


CONCLUSION
The occurrence of relatively high portal blood flow velocities in cirrhotics must remind the examiner of the potential existence of spontaneous portosystemic shunts. Those shunts must be carefully looked for with colour-Doppler ultrasound. In order to assess the true parenchymal blood flow we suggest to perform additional measurements of the right portal trunk and the left portal vein distal to the shunt. With an increase in the severity of liver cirrhosis the incidence of paraumbilical vein patency rises.