From Big Medical Encyclopedia

SPLENOPORTOGRAFIYA (Greek splen a spleen + a portografiya) — a method of contrast X-ray inspection of vessels of portal system with simultaneous contrasting of a splenic vein.

There are three main ways C.: chresselezenochny (direct), chrez-arterial (returnable, indirect) and transhepatic (retrograde).

Indications and contraindications

Indications: esophageal and gastric bleedings of the obscure etiology and not specified localization, disturbances of portal blood circulation, a splenomegaly of not clear genesis, suspicion of primary tumor of a liver or its metastatic defeat. In addition to use with the diagnostic purposes, S. use at the choice of a way of operation on vessels at portal hypertensia (see) and for assessment of results of operation.

As relative contraindications to S. serve hypersensitivity to iodide contrast agents, the acute renal and liver failure, acute mental disorders.

A technique

S. carry out in a specialized X-ray angiographic office.

Chresselezenochny S. was offered in 1951 to Abeatichi and Kampi (S. Abeatici, L. Campi). At its performance, after processing of a surgery field and local anesthesia, make a transdermal puncture of a spleen in the eighth or ninth boundaries-reberye on the left average axillary line; the needle is entered on depth of 3 — 5 cm. The injection of radiopaque substance in tissue of a spleen (20 — 30 ml of 50 — 70% of solution of Urografinum, Urotrastum, Verografinum, etc.) is made by means of the automatic syringe with a speed of 6 — 8 ml/sec. The X-ray analysis is carried out with a speed of 1 — 2 picture of 1 sec. during 8 — 12 sec. A contrast agent comes to veins of a spleen, then to splenic and portal veins and further to intra hepatic portal branches (see fig. 4 and 5 to St. Portal hypertensia ). The main lack of a method is possibility of heavy complications (internal bleeding, a rupture of a spleen, etc.). In a wedge, practice chresselezenochny S. has limited use.

Chrezarterialny S. is a venous phase tseliakografiya (see) or liyenografiya (see). At the selection administration of contrast medium in a celiac trunk or a splenic artery usually on 6 — 9th sec. there is an image of a splenoportal-ny venous trunk representing a venous phase arteriography (see). As a result of essential dilution of a contrast agent at its intra arterial introduction quality of the image of small veins at chrezarterialny S. is worse, than at chresselezenochny, at the same time details of the intraorganic drawing are also lost, picture contrast decreases, but a better understanding about a hemodynamics and the direction of a blood-groove in portal system is created. For upgrading of the image of veins at chrezarterialny S. a number of ways is offered: a pharmakoangiografiya with va-zodilatator (bradikinin, etc.), increase by 2 — 2,5 times of a dose of the entered contrast agent, etc.

Transhepatic S. carry out by a transdermal puncture special a stylet needle of a large intra hepatic branch of a portal vein. Then make catheterization of a splenic vein or its inflows, by Seldinger's method (see. Seldingera method ). 30 — 40 ml of a contrast agent enter selectively into a splenic vein, using the automatic syringe, with a speed of 10 — 15 ml/sec. Make serial shooting with a speed of 2 pictures of 1 sec. during 8 — 12 sec. This way allows to receive more detailed image of portal system and more precisely to judge a hemodynamics in it. At transhepatic S. it is possible to make the selection sounding of separate inflows of a splenic vein and to take blood samples from various segments of portal system for hormonal and other researches.

At chresselezenochny and transhepatic S. in case of need make a manometriya for the purpose of measurement of venous pressure in portal system.

See also Blood vessels, methods of a research .

Bibliography: Vinogradov V. V., etc. Tranearterialnaya (returnable) spleno-portografiya, Vestn. rentgenol. and radio-gramophones., No. 5, page 37, 1970; M and z and e in Item H., Sh and sh-to and N of Accusative and P y l c about in I. M. Atlas of radiodiagnosis of diseases of vessels of portal system, M., 1966; M and x about in N. I. and E N d e r JI. A. Rentgenoarkhitektonika. portal system at portal hypertensia, the Atlas, M., 1973; Stern B. M. Experience of use of a splenoportografiya on one film, Vestn. rentgenol. and radio-gramophones., No. 5, page 44, 1964; Abeatici S. et Campi L. Sur les possibilites de 1'angio-graphie hepatique — la visualization du system e portal (recherches experimentales), Acta Radiol., t. 36, p. 383, 1951; L e g e r L. Spleno-portographie, P., 1955, bibliogr.; Pereira A. S. La m6thode phlebogra-phique dans l ’6tude des troubles de la circulation du systfcme porte, Lyon chir., t. 46, p. 291, 1951; Reuter St. Redman H. Page of Gastrointestinal angiography, Philadelphia, 1977.

A. P. Savchenko.