Radiology of Liver Circulation by Claude L’Herminé M.D. (auth.)

By Claude L’Herminé M.D. (auth.)

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Retroperitoneal anastomoses. e. in the retroperitoneal space. In normal conditions, such anastomoses occur mainly in the anterior para-renal space where the intestinal veins draining the blood from the right and left colon may drain towards the inferior vena cava either through the lumbar veins (Retzius anastomosis) or the perirenal and gonadal veins (Fig. 33). Similarly the splenic and gastric venous blood may drain through diaphragmatic and retroperitoneal veins towards the inferior vena cava, through the gastro-phrenic and spleno-renal ligaments.

Thus the cirrhotic liver which was a four-way circulatory system (two afferent ways the portal vein and the hepatic artery and two efferent ways: the hepatic veins and the porto-systemic anastomosis) (Fig. 2) becomes a two-way system (one afferent way: the hepatic artery and one efferent way the portal vein) when the hepatic venous bed obstruction is severe enough (Fig. 39). e. an arterioportal reflux. It will be all the more easily evidenced as the arterial flow rate is higher, the intra- 60 hepatic arterio-portal shunting more developed and the hepatofugal portal flow rate more increased.

Indeed portal vein opacification through hepatic artery injection of contrast medium has been documented in some cases of portal thrombosis (13). It is, however, an uncommon finding in clinical circumstances as sinusoidal pressure and blood flow rate within the liver are normal. In fact we found out this hemodynamic change only as a transient phenomenon at an early stage of a portal thrombosis (Fig. 20). In most cases, the contrast medium injected into the hepatic artery normally flows through the sinusoids to join the hepatic veins.

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