Pre-operative angiographic assessment of portal venous hypertension

Fifty-three patients with portal venous hypertension underwent angiographic evaluation of the portal venous system. Arteriography was found to provide adequate opacification of the portal system in 52 patients. Arterial portography is a safer method than splenoportography and provides informaiton not obtainable by the latter method. Thus, hepatic arteriography demonstrated 2 unsuspected hepatomas in the present series. Catheterization of the hepatic veins and measurement of the wedged hepatic venous pressure provide a reliable estimate of the total portal pressure and of the severity of the portal venous hypertension. Vena caval pressure measurements and inferior vena cavography are helpful in the diagnosis of surprahepatic causes of portal hypertension, such as constrictive pericarditis and inferior vena caval diaphragm, and are also useful in the diagnosis of vena caval hypertension due to caudate lobe enlargement. Combined arteriography and venous studies are recommended as the initial radiological approach in all patients with portal hypertension who are being considered for portal-systemic shunt surgery.