Prospective study comparing different indirect methods to measure portal pressure.
OBJECTIVE
To compare the accuracy of wedged hepatic venous pressure (WHVP) measurement with use of an end-hole catheter or an occlusion-balloon catheter versus direct portal pressure (PP) measurement in patients with cirrhosis with sinusoidal portal hypertension and to investigate the factors that affect the results of these indirect measurements.


METHODS
In a cohort of 174 patients with cirrhosis referred for transjugular intrahepatic portosystemic shunt creation, indirect PP was measured with an end-hole catheter and an occlusion-balloon catheter placed in the right hepatic vein. Direct PP was measured by a pigtail catheter in the main branch of the portal vein.


RESULTS
PP was more accurately estimated by the occlusion-balloon technique: mean WHVP measurements were 25.5 mm Hg ± 7.9 and 30.6 mm Hg ± 13.9, respectively, for the occlusion-balloon and end-hole catheter techniques, and the direct PP measurement was 25.0 mm Hg ± 7.0. The median absolute differences between direct and the indirect methods were 6.0 mm Hg with the end-hole catheter and 2.0 mm Hg with the occlusion-balloon catheter (P < .0001, signed-rank test). Relative to direct PP measurements, the occlusion-balloon technique overestimated pressures in cases of higher Model for End-Stage Liver Disease (MELD) scores (Spearman ρ = -0.24; P = .0005).


CONCLUSIONS
Compared with direct PP measurements, agreement was clearly higher for indirect WHVP measurement with occlusion-balloon catheters versus end-hole catheters. However, in patients with a high MELD score, there was an overestimation of PP with the occlusion-balloon method.
Department of Radiology, University Hospitals Leuven, Leuven, Belgium. geert.maleux@uzleuven.be
Geert
G
Maleux
Endry
E
Willems
Steffen
S
Fieuws
Sam
S
Heye
Johan
J
Vaninbroukx
Wim
W
Laleman
David
D
Cassiman
Chris
C
Verslype
Frederik
F
Nevens
D000328:Adult; D000368:Aged; D021721:Balloon Occlusion; D001530:Belgium; D001795:Blood Pressure Determination / Q000295:instrumentation / Q000379:methods*; D002404:Catheterization / Q000295:instrumentation; D057785:Catheters; D004867:Equipment Design; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D017082:Portal Pressure; D011169:Portal Vein / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies