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Shoichi Matsutani - One of the best experts on this subject based on the ideXlab platform.
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To-and-fro waveforms in the left Gastric Vein in portal hypertension
Journal of Medical Ultrasonics, 2012Co-Authors: Shoichi Matsutani, Hideaki MizumotoAbstract:Unusual to-and-fro waveforms were demonstrated in the left Gastric Vein on Doppler sonograms in four patients with liver cirrhosis. The patterns of the to-and-fro waveforms were diverse in each of the patients: both hepatopetal and hepatofugal flow occurred in a single waveform in case 1, changes in the flow direction with flow interruption were noted in case 2, and changes in flow direction without observation of flow interruption and changes after meals were noted in cases 3 and 4, respectively. These waveforms may represent a transitional phase during the development of a portal systemic shunt in patients with portal hypertension.
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blood flow parameters in the short Gastric Vein and splenic Vein on doppler ultrasound reflect Gastric variceal bleeding
European Journal of Radiology, 2010Co-Authors: Hitoshi Maruyama, Shoichi Matsutani, Hiroshi Ishii, Takeshi Ishihara, Toshio Tsuyuguchi, Masaharu Yoshikawa, Osamu YokosukaAbstract:Abstract Purpose Hemodynamic features associated with the bleeding from Gastric fundal varices (FV) have not been fully examined. The purpose of this study was to elucidate hemodynamics in the short Gastric Vein (SGV) which is a major inflow route for FV and flow direction of the splenic Vein (SV) in relation to bleeding FV. Materials and Methods The subject of this retrospective study was 54 cirrhotic patients who had medium- or large-sized FV (20 bleeders, 34 non-bleeders) on endoscopy with SGV on both angiogram and sonogram. Diameter, flow velocity, flow volume of SGV and flow direction in the SV were evaluated by Doppler ultrasound. Results Diameter, flow velocity and flow volume of SGV were significantly greater in bleeders (9.6 ± 3.1 mm, 11.4 ± 5.2 cm/s, 499 ± 250.1 ml/min) than non-bleeders (6.5 ± 2.2 mm, p = 0.0141; 7.9 ± 3.3 cm/s, p = 0.022; 205 ± 129.1 ml/min, p = 0.0031). SV showed forward flow in 37 (68.5%), to and fro in 3 (5.6%) and reversed flow in 14 patients (25.9%). The frequency of FV bleeding was significantly higher in case with reversed or “to and fro” SV flow (11/17) than forward SV flow (9/37, p = 0.0043). The cumulative bleeding rate at 3 and 5 years was significantly higher in patients without forward SV flow (38.8% at 3 years, 59.2% at 5 years) than in patients with forward SV flow (18.7% at 3 years, 32.2% at 5 years, p = 0.0199). Conclusion Advanced SGV blood flow and reversed SV flow direction may be a hemodynamic features closely related to the FV bleeding.
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Therapeutic effect of balloon-occluded retrograde transvenous obliteration for Gastric varices in relation to haemodynamics in the short Gastric Vein
The British journal of radiology, 2009Co-Authors: Hidehiro Okugawa, Shoichi Matsutani, Hitoshi Maruyama, Susumu Kobayashi, Hiroaki Yoshizumi, O YokosukaAbstract:The aim of this study was to elucidate the relationship between the therapeutic effect of balloon-occluded retrograde transvenous obliteration (B-RTO) and haemodynamic features in the short Gastric Vein (SGV) in patients with Gastric fundal varices (GV). The subjects in this retrospective cohort study comprised 34 patients who had moderate- or large-grade GV with the SGV both on retrograde venography and Doppler ultrasound. The diameter, flow velocity and flow volume in the SGV measured by Doppler ultrasound before B-RTO with 1 h balloon occlusion were compared with the therapeutic effect. Embolisation of GV was achieved in 30/34 patients (88.2%): 27 by initial B-RTO and 3 by second B-RTO. Flow velocity and flow volume in the SGV before B-RTO were significantly lower in the 27 patients with a complete effect on initial B-RTO (7.19+/-2.44 cm s(-1), p = 0.0246; 189.52+/-167.66 ml min(-1), p = 0.002) than in the 7 patients with an incomplete effect (10.41+/-5.44 cm s(-1), 492.14+/-344.94 ml min(-1)). Neither endoscopy nor contrast-enhanced CT had recurrent findings of GV in the subject during the follow-up period (94-1440 days; mean, 487.2+/-480.5 days). In conclusion, haemodynamic evaluation of the SGV using Doppler ultrasound may be useful for the prediction of the therapeutic effect of B-RTO.
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Aneurysm of the left Gastric Vein in a patient with portal hypertension.
Journal of medical ultrasonics (2001), 2008Co-Authors: Shoichi Matsutani, Hideaki MizumotoAbstract:varices in 1998: hemoglobin, 10.7 g/dl; platelet count, 9.0 × 10/mm; aspartate transaminase, 58 U/l; alanine transaminase, 53 U/l; serum albumin, 4.4 g/dl; total bilirubin, 1.1 mg/dl; and blood ammonia, 110 μg/ml. The most recent data were: hemoglobin, 12.1 g/dl; platelet count, 4.3 × 10/ mm; aspartate transaminase, 57 U/l; alanine transaminase, 36 U/l; serum albumin, 2.9 g/dl; total bilirubin, 5.2 mg/dl; and blood ammonia, 61 μg/ml. The grade of liver dysfunction changed from A to C according to the Child classifi cation over the period 1998–2008.
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Hemodynamic response of the left Gastric Vein to glucagon in patients with portal hypertension and esophageal varices.
Ultrasound in medicine & biology, 2003Co-Authors: Shoichi Matsutani, Hideaki Mizumoto, Takeshi Fukuzawa, Goro Sato, Hitoshi Maruyama, Hiromitsu SaishoAbstract:Abstract Flow direction and flow velocity of the left Gastric Vein (LGV) and the portal Vein (PV) were examined by a Doppler sonographic machine in 33 patients with esophageal varices, before and after venous injection of glucagon (1 mg). In two patients with hepatopetal blood flow in the LGV, the flow direction changed to hepatofugal after injection of glucagon. In 31 patients with hepatofugal blood flow in the LGV, a significant increase of flow velocity was observed in the LGV in 18 patients (58.1%) and the changes (26.4 ± 24.6%) were significantly larger than those in the PV (7.9 ± 16.0%). The changes in flow velocity decreased in the LGV as the diameter of the LGV and the size of varices increased. In conclusion, glucagon increased collateral blood flow in the LGV in portal hypertension. However, the grade of the response decreased as the grade of portal hypertension increased. (E-mail: matsu@med.m.chiba-u.ac.jp)
Hitoshi Maruyama - One of the best experts on this subject based on the ideXlab platform.
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left Gastric Vein based noninvasive test for esophageal varices a same day comparison of portal hemodynamic assessment with endoscopic appearance
Clinical and translational gastroenterology, 2018Co-Authors: Hitoshi Maruyama, Kazufumi Kobayashi, Soichiro Kiyono, Sadahisa Ogasawara, Yoshihiko Ooka, Eiichiro Suzuki, Tetsuhiro Chiba, Naoya KatoAbstract:To examine the effect of hemodynamic assessment of the left Gastric Vein (LGV) as a noninvasive test to diagnose esophageal varices (EV) in cirrhosis patients. This cross-sectional study consisted of 229 cirrhosis patients (62.7 ± 11.8 years; Child-Pugh score 5–14). One hundred fifty-four patients had EV (67.2%; small, 53; medium, 71; large, 30). All patients underwent a blood test and Doppler ultrasound followed by upper gastrointestinal endoscopy on the same day. The diagnostic ability for EV was compared between LGV-related findings and the platelet count/spleen diameter ratio (Plt/Spl). The detectability of the LGV was higher in patients with EV (129/144, 89.6%) than in those without (35/75, 46.7%; p < 0.0001), and was higher in those with large EV (30/30, 100%) than in those without (134/199, 67.3%; p = 0.0002). The positive detection of the LGV showed 100% sensitivity and negative predictive value (NPV) to identify large EV in the whole cohort and compensated group (n = 127). The best cutoff value in the LGV diameter was 5.35 mm to identify large EV, showing 0.753 area under the receiver operating characteristic curve (AUROC) with 90% sensitivity and 96.5% NPV. The Plt/Spl showed 62.1% sensitivity and 87.1% NPV, and the best cutoff value was 442.9 to identify large EV with 0.658 AUROC, which was comparable to LGV-based assessment (p = 0.162). This same-day comparison study demonstrated the value of LGV-based noninvasive test to identify large EV with high sensitivity and NPV in cirrhosis patients at a lower cost.
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blood flow parameters in the short Gastric Vein and splenic Vein on doppler ultrasound reflect Gastric variceal bleeding
European Journal of Radiology, 2010Co-Authors: Hitoshi Maruyama, Shoichi Matsutani, Hiroshi Ishii, Takeshi Ishihara, Toshio Tsuyuguchi, Masaharu Yoshikawa, Osamu YokosukaAbstract:Abstract Purpose Hemodynamic features associated with the bleeding from Gastric fundal varices (FV) have not been fully examined. The purpose of this study was to elucidate hemodynamics in the short Gastric Vein (SGV) which is a major inflow route for FV and flow direction of the splenic Vein (SV) in relation to bleeding FV. Materials and Methods The subject of this retrospective study was 54 cirrhotic patients who had medium- or large-sized FV (20 bleeders, 34 non-bleeders) on endoscopy with SGV on both angiogram and sonogram. Diameter, flow velocity, flow volume of SGV and flow direction in the SV were evaluated by Doppler ultrasound. Results Diameter, flow velocity and flow volume of SGV were significantly greater in bleeders (9.6 ± 3.1 mm, 11.4 ± 5.2 cm/s, 499 ± 250.1 ml/min) than non-bleeders (6.5 ± 2.2 mm, p = 0.0141; 7.9 ± 3.3 cm/s, p = 0.022; 205 ± 129.1 ml/min, p = 0.0031). SV showed forward flow in 37 (68.5%), to and fro in 3 (5.6%) and reversed flow in 14 patients (25.9%). The frequency of FV bleeding was significantly higher in case with reversed or “to and fro” SV flow (11/17) than forward SV flow (9/37, p = 0.0043). The cumulative bleeding rate at 3 and 5 years was significantly higher in patients without forward SV flow (38.8% at 3 years, 59.2% at 5 years) than in patients with forward SV flow (18.7% at 3 years, 32.2% at 5 years, p = 0.0199). Conclusion Advanced SGV blood flow and reversed SV flow direction may be a hemodynamic features closely related to the FV bleeding.
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Therapeutic effect of balloon-occluded retrograde transvenous obliteration for Gastric varices in relation to haemodynamics in the short Gastric Vein
The British journal of radiology, 2009Co-Authors: Hidehiro Okugawa, Shoichi Matsutani, Hitoshi Maruyama, Susumu Kobayashi, Hiroaki Yoshizumi, O YokosukaAbstract:The aim of this study was to elucidate the relationship between the therapeutic effect of balloon-occluded retrograde transvenous obliteration (B-RTO) and haemodynamic features in the short Gastric Vein (SGV) in patients with Gastric fundal varices (GV). The subjects in this retrospective cohort study comprised 34 patients who had moderate- or large-grade GV with the SGV both on retrograde venography and Doppler ultrasound. The diameter, flow velocity and flow volume in the SGV measured by Doppler ultrasound before B-RTO with 1 h balloon occlusion were compared with the therapeutic effect. Embolisation of GV was achieved in 30/34 patients (88.2%): 27 by initial B-RTO and 3 by second B-RTO. Flow velocity and flow volume in the SGV before B-RTO were significantly lower in the 27 patients with a complete effect on initial B-RTO (7.19+/-2.44 cm s(-1), p = 0.0246; 189.52+/-167.66 ml min(-1), p = 0.002) than in the 7 patients with an incomplete effect (10.41+/-5.44 cm s(-1), 492.14+/-344.94 ml min(-1)). Neither endoscopy nor contrast-enhanced CT had recurrent findings of GV in the subject during the follow-up period (94-1440 days; mean, 487.2+/-480.5 days). In conclusion, haemodynamic evaluation of the SGV using Doppler ultrasound may be useful for the prediction of the therapeutic effect of B-RTO.
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Hemodynamic response of the left Gastric Vein to glucagon in patients with portal hypertension and esophageal varices.
Ultrasound in medicine & biology, 2003Co-Authors: Shoichi Matsutani, Hideaki Mizumoto, Takeshi Fukuzawa, Goro Sato, Hitoshi Maruyama, Hiromitsu SaishoAbstract:Abstract Flow direction and flow velocity of the left Gastric Vein (LGV) and the portal Vein (PV) were examined by a Doppler sonographic machine in 33 patients with esophageal varices, before and after venous injection of glucagon (1 mg). In two patients with hepatopetal blood flow in the LGV, the flow direction changed to hepatofugal after injection of glucagon. In 31 patients with hepatofugal blood flow in the LGV, a significant increase of flow velocity was observed in the LGV in 18 patients (58.1%) and the changes (26.4 ± 24.6%) were significantly larger than those in the PV (7.9 ± 16.0%). The changes in flow velocity decreased in the LGV as the diameter of the LGV and the size of varices increased. In conclusion, glucagon increased collateral blood flow in the LGV in portal hypertension. However, the grade of the response decreased as the grade of portal hypertension increased. (E-mail: matsu@med.m.chiba-u.ac.jp)
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hemodynamic response of the left Gastric Vein to glucagon in patients with portal hypertension and esophageal varices
Ultrasound in Medicine and Biology, 2003Co-Authors: Shoichi Matsutani, Hideaki Mizumoto, Takeshi Fukuzawa, Goro Sato, Hitoshi Maruyama, Hiromitsu SaishoAbstract:Flow direction and flow velocity of the left Gastric Vein (LGV) and the portal Vein (PV) were examined by a Doppler sonographic machine in 33 patients with esophageal varices, before and after venous injection of glucagon (1 mg). In two patients with hepatopetal blood flow in the LGV, the flow direction changed to hepatofugal after injection of glucagon. In 31 patients with hepatofugal blood flow in the LGV, a significant increase of flow velocity was observed in the LGV in 18 patients (58.1%) and the changes (26.4 +/- 24.6%) were significantly larger than those in the PV (7.9 +/- 16.0%). The changes in flow velocity decreased in the LGV as the diameter of the LGV and the size of varices increased. In conclusion, glucagon increased collateral blood flow in the LGV in portal hypertension. However, the grade of the response decreased as the grade of portal hypertension increased.
Rui-rong Wang - One of the best experts on this subject based on the ideXlab platform.
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Evaluation of Gastric fundic and oesophageal varices by 64-row multidetector computed tomography before and after transjugular intrahepatic portosystemic shunt with concurrent left Gastric Vein embolization.
European journal of gastroenterology & hepatology, 2010Co-Authors: Tian-wu Chen, Zhigang Yang, Qi-ling Wang, Ling-ling Qian, Rui-rong WangAbstract:ObjectiveTo determine the utility of 64-row multidetector computed tomography (MDCT) in assessing the changes of Gastric fundic and oesophageal varices before and after transjugular intrahepatic portosystemic shunt (TIPS) with concurrent left Gastric Vein embolization.MethodsTwenty-eight consecutive
Hiromitsu Saisho - One of the best experts on this subject based on the ideXlab platform.
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hemodynamic response of the left Gastric Vein to glucagon in patients with portal hypertension and esophageal varices
Ultrasound in Medicine and Biology, 2003Co-Authors: Shoichi Matsutani, Hideaki Mizumoto, Takeshi Fukuzawa, Goro Sato, Hitoshi Maruyama, Hiromitsu SaishoAbstract:Flow direction and flow velocity of the left Gastric Vein (LGV) and the portal Vein (PV) were examined by a Doppler sonographic machine in 33 patients with esophageal varices, before and after venous injection of glucagon (1 mg). In two patients with hepatopetal blood flow in the LGV, the flow direction changed to hepatofugal after injection of glucagon. In 31 patients with hepatofugal blood flow in the LGV, a significant increase of flow velocity was observed in the LGV in 18 patients (58.1%) and the changes (26.4 +/- 24.6%) were significantly larger than those in the PV (7.9 +/- 16.0%). The changes in flow velocity decreased in the LGV as the diameter of the LGV and the size of varices increased. In conclusion, glucagon increased collateral blood flow in the LGV in portal hypertension. However, the grade of the response decreased as the grade of portal hypertension increased.
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Hemodynamic response of the left Gastric Vein to glucagon in patients with portal hypertension and esophageal varices.
Ultrasound in medicine & biology, 2003Co-Authors: Shoichi Matsutani, Hideaki Mizumoto, Takeshi Fukuzawa, Goro Sato, Hitoshi Maruyama, Hiromitsu SaishoAbstract:Abstract Flow direction and flow velocity of the left Gastric Vein (LGV) and the portal Vein (PV) were examined by a Doppler sonographic machine in 33 patients with esophageal varices, before and after venous injection of glucagon (1 mg). In two patients with hepatopetal blood flow in the LGV, the flow direction changed to hepatofugal after injection of glucagon. In 31 patients with hepatofugal blood flow in the LGV, a significant increase of flow velocity was observed in the LGV in 18 patients (58.1%) and the changes (26.4 ± 24.6%) were significantly larger than those in the PV (7.9 ± 16.0%). The changes in flow velocity decreased in the LGV as the diameter of the LGV and the size of varices increased. In conclusion, glucagon increased collateral blood flow in the LGV in portal hypertension. However, the grade of the response decreased as the grade of portal hypertension increased. (E-mail: matsu@med.m.chiba-u.ac.jp)
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Hemodynamics in the left Gastric Vein after endoscopic ligation of esophageal varices combined with sclerotherapy.
Journal of gastroenterology and hepatology, 2001Co-Authors: Hideaki Mizumoto, Shoichi Matsutani, Hiroshi Ishii, Takeshi Fukuzawa, Goro Sato, Hitoshi Maruyama, Hiromitsu SaishoAbstract:Background and Methods: We examined the changes in portal hemodynamics after endoscopic variceal ligation (EVL) combined with endoscopic injection sclerotherapy (EIS) in relation to post-treatment relapse. The present study included 93 patients who underwent EVL–EIS combination therapy. Portal hemodynamics were examined by Doppler ultrasonography and percutaneous transhepatic portography (PTP). Results: Therapy with EVL–EIS resulted in the complete disappearance of varices in 89 of 93 patients. Cumulative relapse-free rates (Kaplan–Meier method) were 75.8 and 50.2%, respectively, 1 and 3–5 years after treatment. At the end of treatment, the flow in the left Gastric Vein was examined by Doppler ultrasonography. In 50 of 63 patients, the flow remained hepatofugal. In 23 of these patients, PTP was performed at the end of treatment; selective left Gastric venography did not reveal any palisade zone vessels or varices. However, fine blood vessels were seen around the lower esophagus in nine patients, only the paraesophageal Vein was found in 10 patients and these two findings were present in four patients, indicating that collateral blood flow remained in the lower esophagus in 13 of 23 patients. These findings suggest that frequent relapse of varices results from insufficient blockage of blood flow from the left Gastric Vein to the lower esophagus. However, in patients with a patent paraesophageal Vein, long-term effects obtained by EVL–EIS combination therapy were satisfactory. Conclusions: The pattern of the development of collateral left Gastric Veins represents important hemodynamic changes that predict the long-term prognosis of patients after treatment.
Hideaki Mizumoto - One of the best experts on this subject based on the ideXlab platform.
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To-and-fro waveforms in the left Gastric Vein in portal hypertension
Journal of Medical Ultrasonics, 2012Co-Authors: Shoichi Matsutani, Hideaki MizumotoAbstract:Unusual to-and-fro waveforms were demonstrated in the left Gastric Vein on Doppler sonograms in four patients with liver cirrhosis. The patterns of the to-and-fro waveforms were diverse in each of the patients: both hepatopetal and hepatofugal flow occurred in a single waveform in case 1, changes in the flow direction with flow interruption were noted in case 2, and changes in flow direction without observation of flow interruption and changes after meals were noted in cases 3 and 4, respectively. These waveforms may represent a transitional phase during the development of a portal systemic shunt in patients with portal hypertension.
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Aneurysm of the left Gastric Vein in a patient with portal hypertension.
Journal of medical ultrasonics (2001), 2008Co-Authors: Shoichi Matsutani, Hideaki MizumotoAbstract:varices in 1998: hemoglobin, 10.7 g/dl; platelet count, 9.0 × 10/mm; aspartate transaminase, 58 U/l; alanine transaminase, 53 U/l; serum albumin, 4.4 g/dl; total bilirubin, 1.1 mg/dl; and blood ammonia, 110 μg/ml. The most recent data were: hemoglobin, 12.1 g/dl; platelet count, 4.3 × 10/ mm; aspartate transaminase, 57 U/l; alanine transaminase, 36 U/l; serum albumin, 2.9 g/dl; total bilirubin, 5.2 mg/dl; and blood ammonia, 61 μg/ml. The grade of liver dysfunction changed from A to C according to the Child classifi cation over the period 1998–2008.
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Hemodynamic response of the left Gastric Vein to glucagon in patients with portal hypertension and esophageal varices.
Ultrasound in medicine & biology, 2003Co-Authors: Shoichi Matsutani, Hideaki Mizumoto, Takeshi Fukuzawa, Goro Sato, Hitoshi Maruyama, Hiromitsu SaishoAbstract:Abstract Flow direction and flow velocity of the left Gastric Vein (LGV) and the portal Vein (PV) were examined by a Doppler sonographic machine in 33 patients with esophageal varices, before and after venous injection of glucagon (1 mg). In two patients with hepatopetal blood flow in the LGV, the flow direction changed to hepatofugal after injection of glucagon. In 31 patients with hepatofugal blood flow in the LGV, a significant increase of flow velocity was observed in the LGV in 18 patients (58.1%) and the changes (26.4 ± 24.6%) were significantly larger than those in the PV (7.9 ± 16.0%). The changes in flow velocity decreased in the LGV as the diameter of the LGV and the size of varices increased. In conclusion, glucagon increased collateral blood flow in the LGV in portal hypertension. However, the grade of the response decreased as the grade of portal hypertension increased. (E-mail: matsu@med.m.chiba-u.ac.jp)
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hemodynamic response of the left Gastric Vein to glucagon in patients with portal hypertension and esophageal varices
Ultrasound in Medicine and Biology, 2003Co-Authors: Shoichi Matsutani, Hideaki Mizumoto, Takeshi Fukuzawa, Goro Sato, Hitoshi Maruyama, Hiromitsu SaishoAbstract:Flow direction and flow velocity of the left Gastric Vein (LGV) and the portal Vein (PV) were examined by a Doppler sonographic machine in 33 patients with esophageal varices, before and after venous injection of glucagon (1 mg). In two patients with hepatopetal blood flow in the LGV, the flow direction changed to hepatofugal after injection of glucagon. In 31 patients with hepatofugal blood flow in the LGV, a significant increase of flow velocity was observed in the LGV in 18 patients (58.1%) and the changes (26.4 +/- 24.6%) were significantly larger than those in the PV (7.9 +/- 16.0%). The changes in flow velocity decreased in the LGV as the diameter of the LGV and the size of varices increased. In conclusion, glucagon increased collateral blood flow in the LGV in portal hypertension. However, the grade of the response decreased as the grade of portal hypertension increased.
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Hemodynamics in the left Gastric Vein after endoscopic ligation of esophageal varices combined with sclerotherapy.
Journal of gastroenterology and hepatology, 2001Co-Authors: Hideaki Mizumoto, Shoichi Matsutani, Hiroshi Ishii, Takeshi Fukuzawa, Goro Sato, Hitoshi Maruyama, Hiromitsu SaishoAbstract:Background and Methods: We examined the changes in portal hemodynamics after endoscopic variceal ligation (EVL) combined with endoscopic injection sclerotherapy (EIS) in relation to post-treatment relapse. The present study included 93 patients who underwent EVL–EIS combination therapy. Portal hemodynamics were examined by Doppler ultrasonography and percutaneous transhepatic portography (PTP). Results: Therapy with EVL–EIS resulted in the complete disappearance of varices in 89 of 93 patients. Cumulative relapse-free rates (Kaplan–Meier method) were 75.8 and 50.2%, respectively, 1 and 3–5 years after treatment. At the end of treatment, the flow in the left Gastric Vein was examined by Doppler ultrasonography. In 50 of 63 patients, the flow remained hepatofugal. In 23 of these patients, PTP was performed at the end of treatment; selective left Gastric venography did not reveal any palisade zone vessels or varices. However, fine blood vessels were seen around the lower esophagus in nine patients, only the paraesophageal Vein was found in 10 patients and these two findings were present in four patients, indicating that collateral blood flow remained in the lower esophagus in 13 of 23 patients. These findings suggest that frequent relapse of varices results from insufficient blockage of blood flow from the left Gastric Vein to the lower esophagus. However, in patients with a patent paraesophageal Vein, long-term effects obtained by EVL–EIS combination therapy were satisfactory. Conclusions: The pattern of the development of collateral left Gastric Veins represents important hemodynamic changes that predict the long-term prognosis of patients after treatment.
