Percutaneous transhepatic portography. I. Technique and application

Abstract

Percutaneoustranshepatic portography with selective catheterization of the portal vein and its tributaries was performed on 120 patients, of whom 71% had cirrhosis of the liver. The technique was improved by ultrasonically guided puncture, and the procedure was successful in 96% of the examinations. Collateral veins were visualized in 81% and esophageal or gastric varices in 69% of the patients with portal hypertension. The procedure was performed with little risk and discomfort, and portograms of high quality were obtained. Other applications of percutaneous transhepatic catheterization of the portal vein system are discussed.

A Large Spontaneous Splenorenal Shunt in a Patient with Liver Cirrhosis and Uncomplicated Portal Hypertension

“…An enlarged commun-(including increased sensitivity, earlier visualization of the portal venous system, lower contrast loads, and lack icating vein between portal and left renal veins was found which seemed to be formed by the union of the left gastric of need for vasodilators) [55], or transhepatic portography (by percutaneous transhepatic portal catheterization) vein and the cardioesophageal branch of the left inferior phrenic vein which opened into the left renal vein [65]. [56][57][58]. Transhepatic portography in patients with Specific treatments (portocaval shunt or splenectomy) several complications, as reported in the literature [10,14,24,27].…”

“…Percutaneous tosystemic shunts). Noninvasive, nonexpensive, harmless, and rapid techniques are ultrasonography [8,[44][45][46], real-transhepatic portography, improved by ultrasonically guided puncture, may be performed with little risk and time/pulsed Doppler ultrasonography (capable of determining the direction and rate of blood flow in large veins) is proved to be superior with regard to delineation of the portal venous system and esophageal varices [56,57]. In [17,47], color Doppler sonography, and duplex Doppler ultrasonography [21,[48][49][50].…”

“…In [17,47], color Doppler sonography, and duplex Doppler ultrasonography [21,[48][49][50]. Part of the course of the several studies, this procedure was reported to be successful in 96% of the examinations, visualizing collateral veins portocaval anastomotic vessels can be visualized by ultrasonography opposite the left adrenal gland and in the in 81% and varices in 69% of the patients with portal hypertension [56,57]. Arterioportography may be also space between the spleen and the left kidney.…”

“…However, the 'gold standard' methods are changes may be also induced by medical treatment such as administration of -adrenergic blocking agents. In 18 those based on abdominal angiography which are expensive and invasive [55][56][57][58]. In pediatric patients, with a high patients with liver cirrhosis and bleeding from large esophageal varices, after 21 days of treatment with ateno-incidence of spontaneous splenorenal shunting, digital splenoportography with thin flexible needles and small lol, the caliber of splanchnic veins showed a restored response to the breathing maneuvers [66].…”

Digital splenoportography

“…Although it is generally safe with a low complication rate [2,3], it has been largely supplanted by either transhepatic or indirect (arterial) portography to avoid any possibility of splenic injury that could necessitate splenectomy and limit the therapeutic choices for portal venous decompression [4][5][6][7][8]. Recently, a series of splenoportograms was obtained using narrow-gauge fine needles, small doses of dilute contrast material, and digital subtraction imaging to explore the advantages of this procedure in assessing patients with portal hypertension.…”