Video
Measurement of hepatic venous pressure gradient (HPVG)
140.1 Hepatic venous pressure gradient (HVPG) is measured through catheterization of the hepatic vein. Under local anesthesia and sterile conditions, the right jugular vein (or the femoral or antecubital vein) is catheterized, a venous introducer is placed, and a balloon-tipped catheter is advanced under fluoroscopic control into a hepatic vein to measure wedged (WHVP) and free (FHVP) hepatic venous pressure. The FHVP is measured by maintaining the tip of the catheter 'free' in the hepatic vein, 2–4 cm from its opening into the inferior vena cava. The WHVP is measured by inflating a balloon at the tip of the catheter, thereby occluding the hepatic vein. Adequate occlusion of the hepatic vein is confirmed by slowly injecting 5 ml of contrast dye into the vein with the balloon inflated, a procedure that should reveal a typical ‘wedged’ pattern without reflux of the dye or washout through communications with other hepatic veins. The WHVP should be measured until the value remains stable (usually longer than 40 seconds). The HVPG is the difference between WHVP and FHVP.
