J.Jpn. Surg. Soc.. 84(8): 692-702, 1983
Original article
THE EXPERIMENTAL STUDY OF BLOOD COAGULATION AND FIBRINOLYSIS IN ACUTE PORTAL VEIN OCCLUSION
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Second Department of Surgery, Nagoya University School of Medicine, Nagoya, Japan Akimasa Nakao |
In this experimental study in mongrel dogs, 1) changes of blood coagulation and fibrinolysis in portal vein and peripheral vein, 2) histological changes in small intestine and 3) activity of plasminogen activator in small intestine were investigated periodically after acute portal vein ligation with or without heparinized hydrophilic catheter-bypass between portal and femoral vein.
All five dogs died 81-130 minutes (mean 105 minutes) after portal vein ligation. On the other hand, all five bypassed dogs survived in good condition for more than four hours. Acute portal venous congestion caused hypercoagulable state in portal system and apparent DIC occurred in portal system 10 minutes after portal vein ligation. Activity of tissue plasminogen activator which was observed mostly in the endotherial cells of vessels in submucosal layers of small intestine decreased rapidly and disappeared within 20 minutes after portal vein ligation. To the contrary, with the use of the catheter-bypass procedure, no significant changes of blood coagulation and fibrinolysis were observed.
These results indicate clearly that portal venous congestion is the trigger of hypercoagulable state in portal system, which progresses to irreversible DIC in 20 minutes. With the use of the catheter-bypass procedure, portal vein shut-down is performed without any abnormal coagulation and fibrinolysis in portal bed and systemic circulation.
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