Abstract
An improved technique for percutaneous transhepatic portal vein catheterization is descrived in comparison with the old method. It employs a PTC needle to puncture a portalvein branch before PTP needle is used. Using either the old or new method, PTP was carried out in 133 patients with various liver diseases consisting chiefly of liver cirrhosis. The success rate with the new method (90.3%) was much superior to that with the old one (59.0%). Exchange of various shaped catheters and performance of superselective angiography are also easy with the new method due to the application of a "sheath" catheter.
There were 61 complications and unwanted events in 50 of the 133 patients. Puncture of the bile duct was the most frequent complication (28 cases, 21.1%). There was one patient who had to be operated on after PTP procedure because of bile leakage into peritoneum, but no hemothorax or death occurred. The locations and angles of bifurcation or junction of the portal vein and its tributaries were also studied in the portograms. Portosplenic junction was mostly positioned to the right of the Th12 or L1 vertebral body and its angle was about 120°. The left gastric vein and inferior mesenteric vein were positioned near the portosplenic junction in 80% of the cases. From these data, it was concluded that a new method is superior to the old one in terms of safety, technical easiness and success rate, and that to know the location and angle of junction of the portal vein and its tributaries is important in selective catheterization for the study of portal hemodynamics and blood sampling.
