Skip to main content
SpringerLink
Log in

Radiological anatomy of spontaneous splenorenal shunts in patients with chronic liver disease

  • Original Article
  • Published:
Japanese Journal of Radiology Aims and scope Submit manuscript

Abstract

Purpose

We evaluated anatomical variations of spontaneous splenorenal shunt (SSRS) and the prevalence of portosystemic shunts in patients with chronic liver disease by CT.

Materials and methods

A total of 451 patients with chronic liver disease underwent contrast-enhanced computed tomography between October 2010 and April 2011. The prevalence of portosystemic shunts including SSRS and gastrorenal shunt, and the frequency of hepatic encephalopathy were examined. The course of the shunt and the point of confluence with the renal vein of the SSRS were analyzed.

Results

SSRSs or gastrorenal shunts were found in 11.1 and 5.0% of the patients, respectively. Anatomical variations were classified into three types according to the point of confluence as follows: type 1 = the SSRS joined the inferior phrenic vein (n = 33), type 2 = the SSRS joined the gonadal vein (n = 7), and type 3 = the SSRS joined the left renal vein (n = 14). The course of the SSRS from the splenic hilum was classified as medial (n = 46), posterior (n = 2), or anterolateral (n = 2).

Conclusions

SSRSs were classified into three types depending on the confluence point with the renal vein, and into three types of course. These findings are useful for preoperative information.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Kanagawa H, Mima S, Kouyama H, et al. Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration. J Gastroenterol Hepatol. 1996;11:51–8.

    Article  CAS  PubMed  Google Scholar 

  2. Hirota S, Matsumoto S, Tomita M, Sako M, Kono M. Retrograde transvenous obliteration of gastric varices. Radiology. 1999;211:349–56.

    Article  CAS  PubMed  Google Scholar 

  3. Kiyosue H, Mori H, Matsumoto S, Yamada Y, Hori Y, Okino Y. Transcatheter obliteration of gastric varices. Part 2. Strategy and techniques based on hemodynamic features. Radiographics. 2003;23:921–37.

    Article  PubMed  Google Scholar 

  4. Fujimoto M, Moriyasu F, Nada T, Suginoshita Y. Influence of spontaneous portosystemic collateral pathways on portal hemodynamics in living related liver transplantation in children. Transplantation. 1995;60:41–5.

    Article  CAS  PubMed  Google Scholar 

  5. Castillo-Suescun F, Oniscu GC, Hiddalgo E. Hemodynamic consequences of spontaneous splenorenal shunts in deceased donor liver transplantation. Liver Transplant. 2011;17:891–5.

    Article  Google Scholar 

  6. Ruysch F. Curae posteriors, seu thesaurus antomicus omnium praecedentium maximus. Jaussonio-Waesbergios 1738, Amsterdam.

  7. Wind PH, Alves A, Chevallier JM, Gillot C, Sales JP, Sauvanet A, et al. Anatomy of spontaneous and gastrorenal venous anastomoses. Surg Radiol Anat. 1998;20:129–34.

    CAS  PubMed  Google Scholar 

  8. Zardi EM, Uwechie V, Caccavo D, Maira N, Cacciapaglia PF, Matteo FD, et al. Portosystemic shunts in a large cohort of patients with liver cirrhosis: detection rate and clinical relevance. J Gastroenterol. 2009;44:76–83.

    Article  PubMed  Google Scholar 

  9. Tarantino G, Citro V, Conca P, Riccio A, Tarantino M, Capone D, et al. What are the implications of the spontaneous spleno-renal shunts in liver cirrhosis. BMC Gastroenterol. 2009;9:89–100.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Numata K, Tanaka K, Kiba T, Saito S, Shirato K, Kitamura T, et al. Use of balloon-occluded retrograde transvenous obliteration with etholoamine oleate for the treatment of hepatic encephalopathy in a cirrhotic patient with a large spontaneous splenorenal shunt. J Gastroenerol. 1998;33:424–7.

    Article  CAS  Google Scholar 

  11. Takashimizu S, Watanabe N, Kojima S, Kagawa T, Mine T, Myojin K, et al. Efficacy of balloon-occluded retrograde transvenous obliteration performed in a patient with primary biliary cirrhosis with severe recurrent hepatic encephalopathy due to splenorenal shunt. Tokai J Exp Clin Med. 2007;32:70–4.

    PubMed  Google Scholar 

  12. Rousselot L, Moreno A, Panke W. Studies on portal hypertension. The clinical and physiopathologic significance of self established (nonsurgical) portal systemic venous shunts. Ann Surg. 1959;150:384–412.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Farid N, Balkanci F, Guran S, Senaati S, Besim A. A digital splenoportography: more sensitive method of detecting spontaneous splenorenal shunt. Angiology. 1991;42(9):754–9.

    Article  CAS  PubMed  Google Scholar 

  14. Bagheri M, Haiati A, Hossenini M, Ostad SP. Comparison of findings of spontaneous splenorenal shunt in color Doppler sonography with multislice T scan (64 slices) in liver transplant candidates. Eur J Radiol. 2012;81:2027–36.

    Article  PubMed  Google Scholar 

  15. Sugano S, Yamazaki Y, Okajima T, Kubo S, Sumino Y, Abei T. Studies on the relationship between hepatic and splenic density change in dynamic CT in the presence of a large splenorenal shunt in patients with liver cirrhosis. Am J Gastroenterol. 1993;88:80–3.

    CAS  PubMed  Google Scholar 

  16. Chikamori F, Okamoto H, Kuniyoshi N. Relationship between splenorenal shunt/portal vein diameter ratio and systemic hemodynamics in patients with liver cirrhosis. Digestion. 2014;89:133–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Amagasaki Central Hospital, 1-12-1 Shioe, Amagasaki, Hyogo, 661-0796, Japan

    Sachiko Achiwa

  2. Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan

    Shozo Hirota, Yasukazu Kako, Haruyuki Takaki, Kaoru Kobayashi & Koichiro Yamakado

Authors
  1. Sachiko Achiwa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shozo Hirota
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yasukazu Kako
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Haruyuki Takaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kaoru Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Koichiro Yamakado
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shozo Hirota.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Achiwa, S., Hirota, S., Kako, Y. et al. Radiological anatomy of spontaneous splenorenal shunts in patients with chronic liver disease. Jpn J Radiol 35, 206–214 (2017). https://doi.org/10.1007/s11604-017-0623-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11604-017-0623-1

Keywords

Search

Navigation