Findings in percutaneous transhepatic portography and variceal bleeding in cirrhosis

Percutaneous transhepatic portography was performed upon 57 patients with cirrhosis and portal hypertension. Forty-nine patients experienced one or more bleeding episodes from gastroesophageal varices. The portographic findings and the free portal pressure were compared with the occurrence and severity of variceal bleeding. The occurrence of bleeding was related to the large cephalad collaterals from the splenic vein and the short gastric veins and coronary vein arising from the splenic vein, and to high portal pressure. The severity of the bleeding was directly related to the same collaterals and to the degree of extrahepatic shunting. No consistent relationships were noted between variceal bleeding and other collateral systems, including gastroesophageal varices. The results possibly indicate that, in patients with cirrhosis, percutaneous transhepatic portography may be of value in planning treatment and assessing the prognosis.