Percutaneous transhepatic catheterization of the portal vein for the study of portal hemodynamics and shunts. A preliminary report.

A technique for catheterizing the portal vein transhepatically, based on our method for percutaneous transhepatic cholangiography, is described. Using this technique, quantitation of the intrahepatic shunt and extrahepatic shunt from the splenoportal axis is possible. It involves injection of 99mTc-macroaggregated albumin into the splenic vein at the splenic hilum and 131I-macroaggregated albumin into the portal trunk, followed by differential counting over predetermined areas of the liver and lungs. Catheterization was successful in 20 of 30 patients in whom it was attempted. The intrahepatic shunt indices varied from 1.0 to 78.4% and the extrahepatic shunt indices ranged from 0 to 49.9%. These values appeared to correlate closely with the size of collaterals opacified by portography.