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Updated: Jul 18, 2026
Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
Published on: June 18, 2020
The transjugular route: the key hole to the liver world
M Senzolo1, P Burra, E Cholongitas
1Liver Transplantation and Hepatobiliary Unit, Royal Free Hospital, London, Pond Street, London NW3 2QG, UK.
Insights
The transjugular approach offers minimally invasive management for liver cirrhosis complications, including portal hypertension and liver transplant issues. Training hepatologists in these techniques can expand access to vital diagnostic and therapeutic procedures.
Area of Science:
- Interventional Radiology
- Hepatology
- Transjugular Procedures
Background:
- Portal hypertensive complications significantly contribute to morbidity and mortality in liver cirrhosis patients.
- Current management often involves invasive surgical procedures.
Purpose of the Study:
- To highlight the utility of the transjugular route for managing portal hypertensive complications and liver transplantation-related venous issues.
- To advocate for the integration of transjugular interventional radiological skills within specialized hepatology and liver transplant teams.
- To explore the potential for training hepatologists in basic transjugular procedures to increase accessibility.
Main Methods:
- Utilizing the transjugular route for minimally invasive procedures.
- Procedures include non-surgical management of portal hypertension, therapy for liver transplant venous complications, monitoring hepatic venous pressure gradient, treating hepatic venous obstruction syndromes, and performing transjugular liver biopsies.
- Retrograde evaluation of the portal vein is also facilitated.
Main Results:
- The transjugular route provides a safe and effective minimally invasive option for a range of hepatic interventions.
- These procedures can be combined in a single session, improving efficiency.
- Integration of these skills can enhance outcomes for cirrhotic patients, especially those awaiting liver transplantation.
Conclusions:
- Transjugular interventional radiology is crucial for specialized hepatological centers, particularly liver transplant centers.
- Training hepatologists in simpler procedures like transjugular liver biopsy and hepatic venous pressure gradient measurement can broaden the application of these techniques.
- The transjugular approach offers a 'key hole' to advanced liver diagnostics and therapeutics.
Abstract:
Portal hypertensive complications are major causes of morbidity and mortality in patients with liver cirrhosis. The advent of the transjugular route with its minimal access allows non-surgical management of portal hypertension, therapy of venous complications of liver transplantation, monitoring of therapy for portal hypertension, hepatic venous pressure gradient and is also the major route to treat hepatic venous obstruction syndromes. In addition, the transjugular route is a safe route to perform a liver biopsy (transjugular liver biopsy) and allows retrograde evaluation of the portal vein. All these procedures can be combined in the same session. These hepatic interventional radiological skills should be incorporated into the expertise of the liver team in specialised hepatological centres, particularly in liver transplant centres as they are especially useful in improving outcomes of cirrhotic patients on the liver transplantation waiting list. A limitation in achieving this goal, could be the number of experienced radiologists, but hepatologists can be trained, at least for the most simple procedures (transjugular liver biopsy and hepatic venous pressure gradient). This would allow wider applicability and use of these diagnostic and therapeutic techniques, all through a 2 mm hole in the neck--the key hole to the liver world.
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