liver cirrhosis | Acta Medica Marisiensis

The aim of our study was to investigate the value of Doppler ultrasonography of the portal vein and hepatic artery in liver cirrhosis and to detect any relationship between the ultrasonographic changes and the severity of the portal hypertension and hepatic failure.
Methods: The study comprised 112 patients diagnosed with cirrhosis who had different degrees of esophageal varices, no ascites and who had been divided into groups according to Child-Pugh score. We evaluated the portal vein and hepatic artery velocities and we calculated the hepatic artery resistance and pulsatility index.
Results: Our data suggest that in patients with cirrhosis there is a significant correlation between the pulsatility index and the size of esophageal varices (p < 0.0001) and between the portal velocity and the size of esophageal varices (p < 0.0001). We found a significant inverse correlation between the portal velocity and the pulsatility index (r = -0.63) and a negative correlation between the portal velocity and the resistance index (r = -0.23).There was no correlation between the portal velocity and the peak systolic arterial flow (r = 0.017). There were no statistical differences of the studied portal vein and hepatic artery hemodinamics to different stages of liver
disease.
Conclusion: Portal vein and hepatic artery hemodinamics are unrelated to the degree of hepatic failure. In patients with cirrhosis the hepatic artery pulsatility index is correlated with the severity of the portal hypertension respectively with the degree of esophageal varices. Doppler ultrasound determination of these indices may contribute to a non-invasive evaluation of varices.

Introduction: Hepatocellular carcinoma is the most frequent primary malignant tumor of the liver, being linked in 80% of cases with viral hepatitis ”B” or “C”. Treatment remains a challenge especially in cases with associated hepatic cirrhosis, where preoperative arterial chemoembolization followed by liver resection is recommended.
Case report: We discuss the case of a 64 years old cirrhotic patient, diagnosed by echography, computed tomography, magnetic resonance cholangiography with hepatocellular carcinoma (64x52x46 mm). Preoperative chemoembolization was performed with Lipiodol and 5-FU by supra-selective catheterization of left hepatic artery, followed by favorable radiologic response. Two weeks after embolization, the patient was admitted in Surgical Clinic No. 1 Targu Mures where an atypical resection of the left hepatic lobe (bisegmentectomy II-III) was performed with Harmonic Scalpel. Early and late postoperative evolution was favorable.
Discussions: The principle of arterial chemoembolization is based on the fact that vasculature of primary hepatic tumors is predominantly arterial. Arterial obstruction may lead to ischemic necrosis while tumor embolization combination with a chemotherapeutic agent significantly improves its local concentration. Decrease in tumor size and its vasculature allows for safe hepatic resection especially in the cirrhotic liver.
Conclusion: In case of tumoral cirrhotic liver preoperative chemoembolization decreases intra and postoperative bleeding risk, providing a safe and oncological resection.