Splenoportovenography: safety, success rate and hemodynamic changes, and incidence and natural history of splenic hematoma.

Forty-five non-cirrhotic patients undergoing splenoportovenography (SPV) were studied. SPV was performed successfully in 43 (95.5%) patients. Local pain was encountered in 12 (26.6%) and lasted for a mean (+/- SD) of 7 +/- 3.8 hours. Local tenderness was noted in 17 (37.7%) and lasted for 6.8 +/- 3.7 hours. The mean rise in the pulse rate after the procedure was 6.5 +/- 4.7 beats per minute and the fall in the systolic and diastolic blood pressures was 3.4 +/- 2.5 and 0.8 +/- 1.7 mmHg respectively. Post-SPV splenic hematoma was noted in 3 (6.6%) patients. All were subcapsular, at the site of puncture, and disappeared by the seventh day. There was no difference in the age, change in the pulse rate, and fall in systolic or diastolic blood pressures between those who developed and those who did not develop hematoma. One patient required one unit of blood transfusion. There were no deaths. SPV was noted to be a simple and safe procedure with a high success rate with minimal morbidity and no mortality.

Safe splenoportography.

The records of 37 patients who had undergone splenoportography, including one group of 12 who were studied before 1976 and a second group of 25 who were studied after 1977, were reviewed. The primary difference was that in the second group, the tract in the spleen was occluded with absorbable gelatin sponge (Gelfoam) plugs as the needle was withdrawn. In addition, there were minor changes in technique, such as changes in the needle puncture angle and entry site. When the new technique was used, there was a significant decrease in the complications traditionally associated with splenoportography. This procedure is safe and deserves to be considered the procedure of choice in patients in whom precise anatomic information is needed preoperatively that cannot be obtained with noninvasive procedures such as ultrasound or magnetic resonance imaging.

[Complications of angiography (author's transl)]. / Komplikationen bei Angiographien.

Report on complications on review of 2163 angiographic examinations-with comparison to these reported in the literature-with the resulting finding that there is no difference. The problems occuring in comparing individual data in this regard are pointed out.

[Splenoportography: still important technic. New prospects (author's transl)]. / Splénoportographie: une technique toujours actuelle. Nouvelles perspectives.

Splenoportography still plays today an important role among angiographic examinations used in the study of portal hypertension. The authors arrived at these conclusions after studying the results obtained in more than 500 examinations carried out. In the text, they give a few details of the technic used to improve the photographic result and to reduce the risk of the examination.

[Changes following splenoportography or lymphography, respectively]. / Zmeny po splenoportografii, resp. po lymfografii.

Lipidol deposits remaining in lymph nodes following lymphography evoke a tissue reaction of various degree. Most probably, the material injected during splenoportography may lead to storage phenomena in the reticuloendothelium of the liver.

Improved safety of splenoportography by plugging of the needle tract.

Splenoportography, a useful preoperative diagnostic procedure in patients with portal hypertension, has been largely discontinued because of the risk of hemorrhage. We have used both Ivalon and Gelfoam in particle and plug form to plug the needle tract after splenoportography. Initial studies were conducted on six dogs. Plugging of the needle tract by injection of suspensions of small Gelfoam or Ivalon particles resulted in intravasation of these particles into the splenic vein. This was demonstrated by radioactive tagging of particles and the direct collection of splenic blood during the intrasplenic injection. Plugging of the splenic needle tract with compressed Gelfoam caused immediate, complete cessation of bleeding in fully heparinized animals. Because of these experimental results, five humans with decreased platelet counts and severe portal hypertension underwent successful splenoportography without significant hemorrhage. At surgery, successful plugging of the needle tract by Gelfoam was confirmed.

Arterioportography.

Arterioportography has superseded splenoportography which has given inadequate and at times misleading information. Eighty-two arterioportograms have been done in 78 patients with portal hypertension. The arterial phase may disclose malignancy, pancreatitis, diminished liver perfusion and the venous phase flow reduction, occlusion and the presence of thrombus. Arterioportography should provide evidence of suitability for specific shunts and features relevant to the performance of of a mesocaval or distal spleno-renal shunt are given in detail. An attempt is made to relate arterioportography and transhepatic portal catherisation into a combined function in the management of patients with portal hypertension.

[Transjugular puncture of the portal vein. Portography and selective phlebography of abdominal organs. An experimental study in dogs (author's transl)]. / Transjugulare Pfortaderpunktion, Portographie und selektive Phlebographie viszeraler Organe. Eine experimentelle Studie am Hund

Transjugular transhepatic portography is a new method for catheterising the portal vein and its tributaries. In order to gather experience of the method before applying it clinically, the transvenous approach was studied in six dogs. Transjugular portography has the following advantages as compared with umbilical vein catheterization and percutaneous, transhepatic portal vein catherterisation: 1. Because of the relative positions of the jugular veins, vena cava and portal vein, manipulation of the catheter for selective phlebography is simpler. 2. There is no risk of a haemoperitoneum or bile peritonitis if a correct technique is used since the liver capsule remains intact. 3. In the presence of portal hypertension, it may be possible in future to create an intrahepatic portocaval shunt by the transjugular approach without a major operation. Sclerosis of oesophageal varices is possible, as it is with the other procedures.

[Trans-jugular retrograde portography. Preliminary communication]. / Transjugulare retrograde Portographie

Retrograde portography is carried out through a trans-jugular route. Contrary to previously available techniques of trans-juglar portography, the method does not inflict any trauma on the parenchyma or vessels. Demonstration of the portal system is achied by reserved flow through the liver sinusoids. Together with arterial hepatography and indirect splenic and mesenteric portography, the method provides additional information in various forms of pre-, intra- and post-hepatic block without submitting the patient to any additional risk.

[Accidents and complications of splenoportography]. / Incidenti e complicanze della splenoportografia

The literature concerning accidents and complications of transcutaneous splenoportography is examined and compared with personal experience. The technique used is discussed and some of its advantages with respect to selective arteriography of the coeliac tripod are stressed. It is concluded transcutaneous that splenoportography is free from any particular risk and has no equal in the detailed study of certain alterations of the splenoportal trunk.

Adverse reactions to intravascularly administered contrast media. A comprehensive study based on a prospective survey.

Case reports on 112,003 patients obtained through a prospective survey have been studied and submitted to computer processing. The significant findings have been reviewed and their importance discussedmthe following points are noteworthy: the value of pretesting is doubtful; and routine pretesting is not a recommended procedure. The constant readiness of a fully equipped emergency tray offers far greater security and assurance of patient safety than the unpredictable and unreliable results of pretesting. The over-all incidence of nonfatal reactions is lower than has been prviously indicated: 5.65 per cent for intravenous urography; and 2.33 per cent for intravascular studies. The incidence of fatal reaction (1 in 10,000) is higher than that reported on the basis of retrospective studies. This figure may or may not be duplicated in the next 100,000 examinations. The cause of death in some patients may be related to a combination of factors-primary disease, diagnostic procedure, and contrast medium. The over-all incidence of adverse reactions in patients with allergy is about twice that in the general population. The incidence of adverse reactions is highest in the third and fourth decades, and lowest at either end of the age spectrum. Incidence of reactions is equal in both sexes. History of reaction to previous examinations is not a contraindication to re-examination. The incidence is approximately 3 times that of the general population. Rapid injection rate, in intravenous urography, is accompanied by fewer reactions than a slow injection rate. A slow injection rate in intravenous cholangiography is accompanied by fewer ractions than a rapid injection rate. It is anticipated that this program will continue, so that additional meaningful data and significant information will be accumulated. The members of our Committee are of the firm belief that this program will become the foundation of a permanent national and international adverse reaction reporting system, thus meeting a great need. We invite the collaboration and support of all those interested and involved in the many phases of contrast medium work.

Celiac arteriography following percutaneous splenoportography.

Splenic arteriography was performed in 14 patients immediately following antecedent splenoportography. Arteriographic evidence of splenic hematoma was demonstrated in 3 patients while in the remaining 11, no arteriographic abnormalities were detected.