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

Ischemia Clinical Trial

— splen ligation  

Official title:

Hemodynamic Modulations to Ameliorate Sinusoidal Injuries After Extended Liver Resections: the Role of Splenic Artery Ligation and Porto-caval Shunt in a Series of Patients

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT05459883
• Other study ID #: 418/18-04-2022
• Status: Completed
• Start date: January 1, 2017
• Est. completion date: December 31, 2021

Study information

• Verified date: July 2022
• Source: Aretaieion University Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial 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.

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 13
• Est. completion date: December 31, 2021
• Est. primary completion date: December 31, 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 75 Years

Eligibility

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

Related Conditions & MeSH terms

• Hepatectomy
• Ischemia
• Liver Regeneration
• Portal Vein
• Reperfusion Injury
• Syndrome

Intervention

Procedure:
• 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

Locations

Country	Name	City	State
Greece	Aretaieion University Hospital	Athens	?tt???

Sponsors (1)

Lead Sponsor	Collaborator
Aretaieion University Hospital

Country where clinical trial is conducted

Greece, 

References & Publications (5)

García-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. — View Citation

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. Review. — View Citation

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. — View Citation

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. — View Citation

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. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	portal vein pressure	change of portal vein pressure from before liver resection to after reperfusion of the liver remnant	through the operation, an average period of two hours
Primary	portal vein flow	change of portal vein flow from before liver resection to after reperfusion of the liver remnant	through the operation, an average period of two hours
Primary	hepatic artery flow	change of hepatic artery flow from before liver resection to after reperfusion of the liver remnant	through the operation, an average period of two hours