title: Diagnostic hepatic haemodynamic techniques: safety and radiation exposure.
abstract: Hepatic venous pressure gradient (HVPG) and transjugular liver biopsy (TJLB) are increasingly used in the management of patients with liver disease. We aimed to describe the safety profile of these procedures, providing data on the intra- and periprocedure complications, radiation exposure and amount of iodinated contrast material used.
  
  
  
  In 106 consecutive patients undergoing HVPG and TJLB data on fluoroscopy time (FT), absorbed radiation dose, equivalent effective dose (mSv) and volume of iodinated contrast material (ICM) were prospectively collected and reviewed, together with clinical and laboratory data. Incidence and severity of procedure-related complications were assessed. In 28 hospitalised patients, creatinine values after 72 hours of the procedure were reviewed to identify contrast-induced nephropathy (CIN).
  
  
  
  Median effective radiation dose was 5.4 mSv (IQR 10 mSv). A total 28.3% of patients exceeded an effective exposure of 10 mSv and 9.4% exceeded 20 mSv. Only age and BMI correlated with radiation dose (R = .327, P=.001 and R = .410, P<.0001 respectively), and only BMI remained independently associated with an exposure over 20 mSv. Procedure-related complications occurred in eight patients (7.5%), and were minor in six cases. Median ICM volume was 12.5 mL. 6/28 patients met the diagnostic criteria for CIN.
  
  
  
  Hepatic venous pressure gradient and Transjugular liver biopsy show a good safety profile and radiation exposure associated with these procedures is in most of the cases low. In hepatic haemodynamic procedures, efforts should be made to reduce the radiation dose in patients with overweight/obesity and to use the minimal possible ICM volume in patients with acute-on-chronic liver failure.
authors: Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Berne, Berne, Switzerland.
authors: Andrej
authors: A
authors: Hari
authors: Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Berne, Berne, Switzerland.
authors: Hari Kumar
authors: HK
authors: Nair
authors: Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Berne, Berne, Switzerland.
authors: Andrea
authors: A
authors: De Gottardi
authors: Clinic for Angiology, Swiss Cardiovascular Center, Inselspital, University of Berne, Berne, Switzerland.
authors: Iris
authors: I
authors: Baumgartner
authors: Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Berne, Berne, Switzerland.
authors: Jean-François
authors: JF
authors: Dufour
authors: Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Berne, Berne, Switzerland.
authors: Annalisa
authors: A
authors: Berzigotti
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000175:diagnosis; D000368:Aged; D003287:Contrast Media; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008099:Liver / Q000473:pathology / Q000528:radiation effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D017082:Portal Pressure; D011829:Radiation Dosage; D000069079:Radiation Exposure; D012189:Retrospective Studies; D013557:Switzerland
chemical_list: D003287:Contrast Media
keywords: hepatic venous pressure gradient; iodinated contrast material; obesity; transjugular liver biopsy