Clinical study
Prospective Study Comparing Different Indirect Methods to Measure Portal Pressure

https://doi.org/10.1016/j.jvir.2011.08.003Get rights and content

Abstract

Purpose

To compare the accuracy of wedged hepatic venous pressure (WHVP) measurement with use of an end-hole catheter or an occlusion-balloon catheter versus direct portal pressure (PP) measurement in patients with cirrhosis with sinusoidal portal hypertension and to investigate the factors that affect the results of these indirect measurements.

Materials and Methods

In a cohort of 174 patients with cirrhosis referred for transjugular intrahepatic portosystemic shunt creation, indirect PP was measured with an end-hole catheter and an occlusion-balloon catheter placed in the right hepatic vein. Direct PP was measured by a pigtail catheter in the main branch of the portal vein.

Results

PP was more accurately estimated by the occlusion-balloon technique: mean WHVP measurements were 25.5 mm Hg ± 7.9 and 30.6 mm Hg ± 13.9, respectively, for the occlusion-balloon and end-hole catheter techniques, and the direct PP measurement was 25.0 mm Hg ± 7.0. The median absolute differences between direct and the indirect methods were 6.0 mm Hg with the end-hole catheter and 2.0 mm Hg with the occlusion-balloon catheter (P < .0001, signed-rank test). Relative to direct PP measurements, the occlusion-balloon technique overestimated pressures in cases of higher Model for End-Stage Liver Disease (MELD) scores (Spearman ρ = −0.24; P = .0005).

Conclusions

Compared with direct PP measurements, agreement was clearly higher for indirect WHVP measurement with occlusion-balloon catheters versus end-hole catheters. However, in patients with a high MELD score, there was an overestimation of PP with the occlusion-balloon method.

Section snippets

Study Design

The present prospective, single-center study was conducted at a tertiary liver unit from 2007 until 2010, and included all patients with cirrhosis considered for transjugular intrahepatic portosystemic shunt creation. The study protocol was approved by the institutional review board of University Hospitals Leuven (approval S 52654), and written informed consent was obtained before all procedures.

The primary aim of the present study was to compare the WHVP values measured with the use of an

Results

Clinical characteristics of the study cohort are summarized in Table 1. Pressure measurements in patients with sinusoidal PH are summarized in Table 2.

Agreement with direct PP was clearly greater for WHVP measurements with balloons than with end-hole catheters. The median absolute differences versus direct PP measurement were 6.0 mm Hg for WHVP measurement with an end-hole catheter and 2.0 mm Hg for WHVP measurement with an occlusion-balloon catheter (P < .0001). With the occlusion balloon, the

Discussion

Measurement and monitoring of PP and portal perfusion pressure gradient has become an important diagnostic and prognostic tool not only in daily clinical hepatologic practice, but also in hepatologic research dealing with evaluation of new drugs that interact with PP (2, 4). Therefore, the correct performance of the procedure and optimization of the technique of hepatic vein pressure gradient measurement is of the utmost importance. Indirect PP measurements with an end-hole catheter or

References (17)

There are more references available in the full text version of this article.

Cited by (31)

  • Transjugular Liver Biopsy

    2021, Techniques in Vascular and Interventional Radiology
    Citation Excerpt :

    The benefit of utilizing the end hole catheter is minimizing catheter exchanges, procedure time and cost. However, some do not favor this technique as it measures only a small portion of the liver when compared to balloon occlusion catheter positioned in the mid portion of the hepatic vein.19 If using the end hole a successful wedge can be confirmed with a small injection of contrast (Fig. 5).

  • Application of CT-based radiomics in predicting portal pressure and patient outcome in portal hypertension

    2020, European Journal of Radiology
    Citation Excerpt :

    Direct measurement of portal pressure has been previously reported and can be achieved through a direct puncture of the portal vein, either through a percutaneous or transjugular approach. However, the direct approach is associated with a higher risk of complication including hepatic hemorrhage, portal vein thrombosis, and intrahepatic arteriovenous fistula [8,11]. Over the past decade, advancements in medical imaging analysis has grown exponentially.

  • Transvenous Pressure Measurements and Liver Biopsy

    2020, Image-Guided Interventions: Expert Radiology Series, Third Edition
  • Chapter 5 - Liver blood flow: Physiology, measurement, and clinical relevance

    2016, Blumgart's Surgery of the Liver, Biliary Tract and Pancreas: Sixth Edition
  • Free Hepatic Vein Pressure Is Not Useful to Calculate the Portal Pressure Gradient in Cirrhosis: A Morphologic and Hemodynamic Study

    2016, Journal of Vascular and Interventional Radiology
    Citation Excerpt :

    This may be a situation in which morphologic changes of hepatic veins are more common than in patients with compensated cirrhosis (21). In addition, the WHVP was measured by using the end-hole technique, which may have a lower agreement with portal pressure compared with the balloon-occlusion method (22,23). However, absolute value differences between the two methods are small (24), and, at least in patients with advanced disease, the balloon-occlusion method may overestimate the portal pressure (24).

View all citing articles on Scopus

None of the authors have identified a conflict of interest.

View full text