Correlation of hepatic and portal wedged venography and manometry with histology in alcoholic cirrhosis and periportal fibrosis.

Histologic, manometric, and direct magnification venographic studies of four patients with portal fibrosis and 10 patients with alcoholic cirrhosis were compared before and for variable periods after portacaval shunt procedures. Unique to this investigation was the availability of postoperative wedged portal vein manometry and venography. In periportal fibrosis (presinusoidal obstruction), portal studies demonstrated portal venular atrophy and occlusions, with egress of contrast material from hepatic sinusoids via hepatic veins; hepatic studies were near normal. The reverse was observed in patients with cirrhosis (postsinusoidal obstruction). The degree of elevation of portal vein pressures did not enable clear discrimination of pre- and postsinusoidal obstruction. Results support classical concepts of pre-and postsinusoidal obstructive disease and confirm the utility of wedge hepatic and portal venography in differentiating these two entities.