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In cases where less than 50% of the vessel is involved, vascular surgeons remove the involved portion of the vessel, and repair the residual artery or vein. [16] Tumors are still borderline resectable even if they involve the superior mesenteric or portal veins, gastroduodenal artery, superior mesenteric vein or colon. [17]
Diagram showing the parts removed with a Whipple's operation. Date: 30 July 2014 (released by CRUK) Source: Original email from CRUK: Author: Cancer Research UK: Permission (Reusing this file) This image has been released as part of an open knowledge project by Cancer Research UK. If re-used, attribute to Cancer Research UK / Wikimedia Commons
In portal hypertension, venous resistance is increased within the portal venous system; when the pressure in the portal venous system increases above that of the systemic, blood is shunted through the portosystemic anastomoses. The shunting of blood and consequential increase of pressure through the collateral veins causes the varicosities.
The human hepatic portal system delivers about three-fourths of the blood going to the liver.The final common pathway for transport of venous blood from spleen, pancreas, gallbladder and the abdominal portion of the gastrointestinal tract [2] (with the exception of the inferior part of the anal canal and sigmoid colon) is through the hepatic portal vein.
The portal vein is not a true vein, because it conducts blood to capillary beds in the liver and not directly to the heart. It is a major component of the hepatic portal system , one of three portal venous systems in the human body; the others being the hypophyseal and renal portal systems.
A dilated portal vein (diameter of greater than 13 or 15 mm) is a sign of portal hypertension, with a sensitivity estimated at 12.5% or 40%. [18] On Doppler ultrasonography , a slow velocity of <16 cm/s in addition to dilatation in the main portal vein are diagnostic of portal hypertension. [ 19 ]
The first is the use of beta-blockers, which reduce portal pressures. Non-selective beta blockers (such as propranolol and nadolol) have been used to decrease the pressure of the portal vein in patients with esophageal varices, and have been shown to regress portal hypertensive gastropathy that has been worsened by medical treatment of varices. [5]
Portal vein; Superior mesenteric vein; Inferior mesenteric vein; The branches conveying the blood to the plexus are named the venae advehentes, and become the branches of the portal vein. The vessels draining the plexus into the sinus venosus are termed the venae revehentes, and form the future hepatic veins. [3]