Highlights
- •Low wall shear stress and prolonged flow stagnation are related to postsplenectomy thrombosis.
- •Anatomorphological features dominate hemodynamic characteristics in the portal venous system.
- •Hemodynamic analysis has potential value for assessing the risk of postsplenectomy thrombosis.
Abstract
Background
The high incidence of thrombosis in the portal venous system following splenectomy
(a frequently adopted surgery for treating portal hypertension in patients with splenomegaly
and hypersplenism) is a critical clinical issue. The aim of this study was to address
whether quantification of postsplenectomy hemodynamics has potential value for assessing
the risk of postsplenectomy thrombosis.
Methods
Computational models were constructed for three portal hypertensive patients treated
with splenectomy based on their preoperative clinical data to quantify hemodynamics
in the portal venous system before and after splenectomy, respectively. Each patient
was followed up for three or five months after surgery and examined with CT to screen
potential thrombosis.
Findings
The area ratio of wall regions exposed to low wall shear stress was small before splenectomy
in all patients, which increased markedly after splenectomy and exhibited enlarged
inter-patient differences. The largest area ratio of low wall shear stress and most
severe flow stagnation after splenectomy were predicted for the patient suffering
from postsplenectomy thrombosis, with the wall regions exposed to low wall shear stress
corresponding well with the CT-detected distribution of thrombus. Further analyses
revealed that postoperative hemodynamic characteristics were considerably influenced
by the anatomorphological features of the portal venous system.
Interpretation
Postoperative hemodynamic conditions in the portal venous system are highly patient-specific
and have a potential link to postsplenectomy thrombosis, which indicates that patient-specific
hemodynamic studies may serve as a complement to routine clinical assessments for
refining risk stratification and postoperative patient management.
Keywords
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Article info
Publication history
Published online: July 09, 2022
Accepted:
July 6,
2022
Received:
February 10,
2021
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
