[5]. In CB syndrome, the umbilical portion of the left portal vein feeds the paraumbilical vein that then leaves the liver and extends toward the umbilicus. Epub 2020 Sep 14. [9] When portal vein lumen is completely obstructed by thrombosis, an orbit sign can be observed through the CT-enhanced scan phase. AJR Am J Roentgenol. Spontaneous umbilical vein recanalization (UVR) may occur in patients with long-standing portal hypertension or liver cirrhosis, serving as a decompressive portosystemic shunt. Vilgrain V, Condat B, Bureau C, et al. fibers,andadipose tissues. [4, 5] . The vessel involved is actually an enlarged paraumbilical vein. 1 C). There was no difference in sex and age between the UVR and non-UVR patient groups. Fondaparinux is effective for acute portal vein thrombosis in decompensated cirrhotic patients, Prevalence of spontaneous hepatofugal portal flow in liver cirrhosis. 5. Careers. [8]. 1 A). The possible reason was that it was a slow and gradual process. AJR Am J Roentgenol. Child-Pugh classification and MELD scores were collected for indicators of liver functional reserve. Become a Gold Supporter and see no third-party ads. Nunez D, Russell E, Yrizarry J, Pereiras R, Viamonte M Jr. Portosystemic communications studied by transhepatic portography. Diffuse PVT can develop into the cavernous transformation of the portal vein, limiting its treatment methods, with complications difficult to control, like bleeding and ascites. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The UVR incidence was 20.2% (50/247) in the cohort. Paraumbilical vein in the cirrhotic patient: imaging with 3D CT angiography. A portosystemic shunt is provided. The paraumbilical veins arise from the left portal vein and connect the portal venous system to the systemic venous system. Check for errors and try again. 496). Patients with cirrhosis experience rapid growth of scar tissue in and around the liver, often functionally obstructing nearby vessels. [6]. The direct flow (i.e. The paraumbilical vein was approximately 10 mm in diameter and located at a depth of 36 mm from the skin layer ( Fig. The umbilical vein does not suddenly expand, and the progressive process would not relieve the portal vein pressure, while the incidence of bleeding and ascites does not decrease. The patients free of ascites in the UVR group and the non-UVR group accounted for 34% and 23%, respectively, and there was no statistical difference in the severity of ascites (P = .296), indicating that UVR did not change the clinical manifestations of ascites. Clinically significant portal hypertension is defined as a gradient >10 mmHg and variceal bleeding may occur at a gradient >12 mmHg. [1] [2] When originally published, the corresponding author's information appeared incorrectly as Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China, 350025 and has been corrected to The Department of Hepatology, First People Hospital of JiuJiang, JiangXi, China, 332000. This work was supported by China National Nature Science Foundation (grant number: 91029720) has been removed from the funding information. Usefulness of a recanalized umbilical vein for vascular reconstruction in pediatric hepatic surgery. The paraumbilical vein occasionally leads to a varix around the umbilicus, a so-called caput medusa. We performed four hepatic CT dynamic enhanced scans (i.e., equilibrium, artery venous, portal venous, and delay phase). Umbilical Vein Recanalization (UVR) may occur in patients with long-standing portal hypertension and liver cirrhosis. As shown in Table Table2,2, patients that were free of esophageal and gastric varices in the UVR group and the non-UVR groups accounted for 10% (5/50) and 11% (11/100), respectively (P>.05). The liver function was accessed by biochemical criterion, Child-Pugh grading and MELD score. Stella S, Giunta S, Galetta F, Cini G, Giusti C. Dilation of Venous Vessels at the Splenic Hilum in Normal Sized Spleens as an Indication of Pathologic Splenic Involvement: Preliminary Results. Lgar AG, Lavoie P. (1985) The recanalized umbilical vein in portal hypertension: a myth. The site is secure. . Enter your email address to receive notifications of new posts. The CT consisted of a Somatom Definition Flash dual-source CT scanner (Siemens AG, Germany) and a light speed 64 VCT helical scanner with a scanning parameter of 120KV, 250mA, a thickness of 5mm, a layer spacing of 5mm, a screw pitch of 0.6, and a matrix of 1512512. [23] Based on the phenomenon that collateral circulation increases the incidence of HE, clogging of collateral vessel recanalization may be used to treat HE, and the ascites and esophageal varices do not significantly aggravate the HE incidence. [24] When HE was clinically found, an abdominal CT scan was done to detect whether it was combined with portal vein collateral branch, which was important for developing a reasonable therapeutic strategy. The https:// ensures that you are connecting to the Usefulness of a recanalized umbilical vein for vascular reconstruction in pediatric hepatic surgery. In cirrhosis, neovascularization causes blood circulation disorders, increases resistance to blood flow, and leads to higher pressure in the portal venous system, resulting in portal hypertension. Under local anesthesia, one of the paraumbilical veins was punctured percutaneously using a 21-gauge needle under short axis ultrasound guidance. Percutaneous transretroperitoneal direct approach to occlude a major shunt in a patient with extrahepatic portal-systemic encephalopathy. Clin Liver Dis 2014;18:28191. Recanalized Umbilical Vein. This process is accompanied by the slow progress of cirrhosis. Tu R, Xia LP, Yu AL, Wu L. Assessment of hepatic functional reserve by cirrhosis grading and liver volume measurement using CT. World J Gastroenterol 2007;13:395661. Pathology The recanalized umbilical vein in . Hepatic venous pressure gradient is a surrogate for the portosystemic pressure gradient. ); hematological system diseases. The Spearman rank correlation analysis showed that umbilical vein diameter was significantly correlated with the portal vein diameter, spleen vein diameter, and superior mesenteric vein diameter (P1=.025, P2=.025, P3=.001<.05, Table Table5).5). [15,16] One of the reopening channels is the umbilical vein. Nunez D, Russell E, Yrizarry J, Pereiras R, Viamonte M, Jr. Portosystemic communications studied by transhepatic portography, [Degree of portal hypertension and risk of recurrent gastrointestinal bleeding in patients with cirrhosis (author's transl)]. FOIA Lee HK, Park SJ, Yi BH, Yeon EK, Kim JH, Hong HS. [13]. The predictive value of successful catheterization based on preprocedural vein diameter was analyzed. Before Medical records of a cohort of patients with cirrhosis (n=247) who were hospitalized at the Digestive Medicine Center of the Second Affiliated Hospital of Nanchang University from January 2012 to October 2015 were accessed. Lafortune M, Constantin A, Breton G, Lgar A, Lavoie P. The Recanalized Umbilical Vein in Portal Hypertension: A Myth. 28, 29, 30 If a patient with PHT develops a patent paraumbilical vein, flow often remains hepatopetal in the main PV despite elevation of the portosystemic . The Beckman Coulter AU5400 automatic biochemical analyzer (USA), Sysmex CA-700 automatic coagulation analyzer (Japan), ARKRAY MJ-11 ammonia detector (Japan), Q450, and the Color Doppler Aplio300 ultrasound system (Toshiba) were applied to diagnostic examinations. J Clin Gastroenterol 2014; 48:178-83. . ); hematological system diseases. Despite a marginal increase in attenuation between the arterial and portal . Clinically significant portal hypertension is defined as a gradient >10 mmHg and variceal bleeding may occur at a gradient >12 mmHg. These multimodality cutting-edge therapeutic approaches, which encompass transjugular, transhepatic-intrahepatic portal vein branch using US guidance, transsplenic-US guidance, trans-ileocolic-mini-laparotomy (i.e., hybrid approach), as well as the trans-recanalized paraumbilical vein either alone or in combination, push the development of PVS . http://creativecommons.org/licenses/by-nc/4.0. Such recanalization may be evident in patients with cirrhosis and portal hypertension. In cirrhotics, the number and caliber of paraumbilical veins increased. Multistage classification statistics were performed using the MannWhitney U test. Pediatr Surg Int 2016;32:5538. Spontaneous portosystemic shunt: relationship to spontaneous encephalopathy and gastrointestinal hemorrhage. The main portal vein bifurcates into a left and right branch, denoted as the portal bifurcation. Dig Dis Sci 2000;45:18614. Semin Intervent Radiol. [3]. No other significant shunt was noted. [7]. 2. Get new journal Tables of Contents sent right to your email inbox, September 03, 2021 - Volume 100 - Issue 35, http://creativecommons.org/licenses/by-nc/4.0, Clinical characteristics of cirrhosis patients with umbilical vein recanalization: A retrospective analysis, Articles in Google Scholar by Qing Shi, MD, Other articles in this journal by Qing Shi, MD, Evaluation of ustekinumab trough levels during induction and maintenance therapy with regard to disease activity status in difficult to treat Crohn disease patients, Acute portal vein thrombosis after hepatectomy in a patient with hepatolithiasis: A case report and review of the literature, Analysis of clinical characteristics and treatment of immunoglobulin G4-associated cholangitis: A retrospective cohort study of 39 IAC patients, A myeloid sarcoma involving the small intestine, kidneys, mesentery, and mesenteric lymph nodes: A case report and literature review, Impact of Obliterative Portal Venopathy Associated With Human Immunodeficiency Virus, Privacy Policy (Updated December 15, 2022). The main portal vein trunk thrombosis accounted for 43.75%, the portal vein + superior mesenteric vein thrombosis accounted for 12.5%, and other locations accounted for 6.25% (Table (Table3).3). [30]. [19]. UVR was found in 20.2% (50/247) of the patients. We performed four hepatic CT dynamic enhanced scans (i.e., equilibrium, artery venous, portal venous, and delay phase). Dig Dis Sci. A reopened umbilical vein was never found. We considered antegrade embolization of the varices by the percutaneous . Portal hypertension is defined as a hepatic venous pressure gradient (HVPG) >5 mmHg. Gupta D, Chawla YK, Dhiman RK, Suri S, Dilawari JB. modify the keyword list to augment your search. [23]. The study is limited in the following aspects: we included a limited number of patients for analysis, and the observation window was a limited period of time. Received 2020 Nov 29; Revised 2021 Jun 30; Accepted 2021 Jul 9. (A) Patients with cirrhosis portal vein thrombosis undergoing splenectomy, accompanied by HE, massive ascites, esophageal varicose vein, and umbilical vein recanalization. Paraumbilical vein access is a reasonable approach to the portal vein in patients with a large amount of ascites or coagulation abnormalities. National Library of Medicine However, our study showed that UVR did not affect the HE incidence. There is controversy regarding the clinical significance of this finding. [1]. Clinical characteristics of cirrhosis patients with umbilical vein recanalization: a retrospective analysis. The size of UVR was 9.9 4.7 mm (range: 526.5 mm) in diameter. [15,16] One of the reopening channels is the umbilical vein. There were 8 cases of esophageal vein ligation (the procedure was performed according to the indications and contraindications, and the patient consent) in the UVR group and 14 cases in the non-UVR group, with no statistical significance between groups (16% vs. 14%, P = .744). In addition, alimentary tract hemorrhage incidence was 36.7% (55/150) in all patients, 32% (16/50) in the UVR group and 39% (39/100) in the non-UVR group, with no statistical significance between groups (P=.402, suggesting that UVR did not affect the occurrence of esophageal varices bleeding. Our case describes a patient with liver cirrhosis who was found to have a continuous umbilical venous hum on a physical exam with imaging findings consistent with a recanalized paraumbilical vein. Spontaneous umbilical vein recanalization (UVR) may occur in patients with long-standing portal hypertension or liver cirrhosis, serving as a decompressive portosystemic shunt. Shi, Qing MDa; Xiong, Kai MDb; Ding, Bin MDa; Ye, XiaoLing MDc,, aThe Department of Gastroenterology, the First People Hospital of JiuJiang, JiangXi, China. The incidence of cavernous transformation of the portal vein was statistically significantly different, that there was 0 case in the UVR group and 8 cases in the non-UVR group (P=.04). In our study, UVR did not affect Child-Pugh classification, the incidence of moderately severe ascites, the esophageal variceal bleeding rate, or PVT. Identification of a patent paraumbilical vein by using Doppler sonography: importance in the diagnosis of portal hypertension. Portal hypertension is increased pressure in the portal vein the main vein that receives blood from the: The increased pressure is most often a symptom of liver disease and is most commonly caused by scarring in the liver ( cirrhosis ). As a library, NLM provides access to scientific literature. 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