Ferlitsch Arnulf, Bota Simona, Paternostro Rafael, Reiberger Thomas, Mandorfer Mattias, Heinisch Birgit, Salzl Petra, Schwarzer Remy, Sieghart Wolfgang, Peck-Radosavljevic Markus, Ferlitsch Monika
Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
Liver Int. 2015 Sep;35(9):2115-20. doi: 10.1111/liv.12783. Epub 2015 Jan 30.
BACKGROUND & AIMS: Despite the important clinical value of hepatic venous pressure gradient (HVPG) and its increasing use, no specific balloon occlusion catheters have been designed to cannulate liver veins. The aim of the study was to evaluate the clinical applicability of a novel balloon (NC) occlusion catheter specifically designed for HVPG measurement.
Comparison of a new CE-certified 7 French balloon occlusion catheter with a 150° angled tip and radiopaque markers (NC, Pejcl Medizintechnik, Austria), to a commonly used straight balloon catheter (SC; Boston Scientific, USA). Successful liver vein cannulation rate, need for extra equipment and total fluoroscopy time were recorded. Experts (>200) and novices (<20) in HVPG measurements were evaluated separately.
566 HVPG measurements taken by 11 investigators (five experts and six novices) were analysed. Overall, HVPG could be successfully measured in 98.7% of cases. The rate of successful liver vein cannulation at first attempt was significantly higher among experts when compared to novices (87.3% vs 67.3%, P < 0.001). Moreover, the rate of successful liver vein cannulation without need for any additional equipment was higher when using the NC, both among experts (NC:91.9% vs SC:80.6%, P = 0.03) and novices (NC:73.3% vs SC:50.7%, P = 0.001). The mean fluoroscopy time needed to cannulate the hepatic vein was significantly shorter in experts as compared to novices [2.37(0.10-26) vs 5.2(0.6-30.2] min, P < 0.0001), but not significantly different between catheters.
Both novices and experts achieve higher liver vein cannulation rates using the new specifically designed catheter. The use of the novel catheter might increase rates of successful liver vein cannulation and reduce the need for additional equipment, especially in novices.
尽管肝静脉压力梯度（HVPG）具有重要的临床价值且应用日益广泛，但尚未设计出专门用于肝静脉插管的球囊闭塞导管。本研究的目的是评估一种专门为测量HVPG设计的新型球囊（NC）闭塞导管的临床适用性。
将一种新的经CE认证的7F球囊闭塞导管（尖端呈150°角且带有不透射线标记，NC，Pejcl Medizintechnik，奥地利）与一种常用的直形球囊导管（SC；美国波士顿科学公司）进行比较。记录成功的肝静脉插管率、额外设备需求和总透视时间。分别对HVPG测量方面的专家（>200例）和新手（<20例）进行评估。
分析了11名研究者（5名专家和6名新手）进行的566次HVPG测量。总体而言，98.7%的病例能够成功测量HVPG。与新手相比，专家首次尝试时肝静脉插管成功率显著更高（87.3%对67.3%，P<0.001）。此外，使用NC时，无论是专家（NC：91.9%对SC：80.6%，P = 0.03）还是新手（NC：73.3%对SC：50.7%，P = 0.001），无需任何额外设备的肝静脉插管成功率都更高。与新手相比，专家肝静脉插管所需的平均透视时间显著更短[2.37（0.10 - 26）对5.2（0.6 - 30.2）分钟，P<0.0001]，但两种导管之间无显著差异。
使用这种新的专门设计的导管，新手和专家的肝静脉插管率均更高。使用新型导管可能会提高肝静脉插管成功率并减少对额外设备的需求，尤其是在新手当中。
