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Updated: May 26, 2026

Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
Published on: June 18, 2020
Measurement of hepatic venous pressure gradient revisited: Catheter wedge vs balloon wedge techniques
S Timothy Chelliah1, Shyamkumar N Keshava, Vinu Moses
1Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India.
Aims:
To evaluate the accuracy of measurement of hepatic venous pressure gradient by catheter wedge as compared to balloon wedge (the gold standard).
Materials And Methods:
Forty-five patients having a clinical diagnosis of intrahepatic portal hypertension were subjected to the two different types of pressure measurements (catheter wedge and balloon wedge) during transjugular liver biopsy under fluoroscopic guidance.
Statistical Analysis:
Spearman's rank correlation coefficient, Bland-Altman plot for agreement, and single measure intraclass correlation were used for analysis of data.
Results:
There was a close correlation between the results obtained by both the techniques, with highly significant concordance (P < 0.0001). Hepatic venous pressure gradients as measured by the catheter wedge technique were either equal to or less than those obtained by the balloon wedge technique.
Conclusions:
The difference in hepatic venous pressure gradients measured by the two techniques is insignificant.
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Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above the...

