Hepatic occlusion venography with a balloon catheter in patients with end-to side portacaval shunts

Hepatic occlusion venography with the aid of a Swan-Ganz balloon catheter represents a significant improvement in the radiographic demonstration of hepatic veins and their alteration in liver disease. It is simple to perform and can be combined with other hemodynamic examinations (e.g., hepatic vein pressure measurements). In this way the morphologic and hemodynamic changes in the pre- and postoperative evaluation of patients with portal hypertension can be investigated simultaneously. The method allows optimal demonstration of large branches of hepatic veins. Overloading of small areas of liver parenchyma with concentrated contrast medium, as in wedged hepatic venography, is avoided. Previously unknown portosplanchnic anastomoses developing after end-to-side portacaval shunt were demonstrated in seven of eight patients using this method. The frequency and size of these collaterals suggest possible hemodynamic and clinical significance.