Elsevier

Clinics in Liver Disease

Volume 18, Issue 4, November 2014, Pages 779-792
Clinics in Liver Disease

Measurement of Portal Pressure

https://doi.org/10.1016/j.cld.2014.07.002Get rights and content

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Key points

  • Measurement of the hepatic venous pressure gradient (HVPG) is the gold standard technique used to quantify the degree portal hypertension in liver disease.

  • In patients with cirrhosis, HVPG measurement provides independent prognostic information on survival and the risk of decompensation.

  • The HVPG response to pharmacologic therapy for portal hypertension identifies which patients benefit most from treatment.

  • Measurement of HVPG helps assess the risk of liver failure and death after liver resection

Rationale

Hepatic vein catheterization with measurement of the hepatic venous pressure gradient (HVPG) is currently the gold standard technique for determining portal pressure. It is calculated as the difference between the wedged hepatic venous pressure (WHVP) and the free hepatic venous pressure (FHVP).2 The WHVP is measured by occluding a main hepatic vein; stopping the blood flow causes the static column of blood to transmit the pressure that is present in the preceding vascular territory—in this

Diagnosis of Portal Hypertension

Hepatic venous pressure gradient is rarely used for diagnostic purposes. Portal hypertension is usually diagnosed on clinical grounds (from the presence of its complications) or based on results of imaging studies. A particular setting in which HVPG might be of diagnostic utility is in investigating ascites that is not obviously caused by portal hypertension. The HVPG can assist with differentiating between a cardiac origin (increase in both FHVP and WHVP, with normal HVPG), tumoral ascites

Summary

Measurement of HVPG remains one of the most useful techniques in hepatology. Hepatic venous pressure gradient is close to the best surrogate marker in chronic liver diseases: it reflects disease severity and has strong prognostic value with regard to survival and decompensation in patients with compensated cirrhosis, during acute bleeding and before liver resection. Furthermore, repeat measurements of HVPG provide unique information on the response to the medical treatment of portal

Acknowledgments

The authors wish to thank R. Borowski and R. Thomlison for their expert secretarial support.

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    The authors declare that they have no conflicts of interest.

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