Name of the Procedure:

Percutaneous Portal Vein Catheterization

Summary

Percutaneous portal vein catheterization is a minimally invasive procedure where a catheter is inserted through the skin and into the portal vein, which carries blood from the intestines, stomach, pancreas, and spleen to the liver. This procedure is usually guided by imaging techniques such as ultrasound or fluoroscopy.

Purpose

The primary purpose of the procedure is to allow for diagnostic imaging, blood sampling, or to administer medications or treatments directly into the portal vein system. It helps in assessing liver function, diagnosing liver conditions, and treating various hepatic diseases.

Indications

• Suspected portal hypertension
• Liver cirrhosis
• Hepatic vein thrombosis
• Need for portal vein pressure measurements
• Portal vein sampling for diagnostic purposes
• Administration of chemotherapy for liver cancer

Preparation

• Patients may need to fast for several hours before the procedure.
• Medications, particularly blood thinners, may need to be adjusted.
• Pre-procedure blood tests and imaging studies (e.g., ultrasound, CT scan) to assess anatomy and any potential complications.

Procedure Description

1. The patient is positioned comfortably, usually supine.
2. Local anesthesia is administered to numb the skin and deeper tissues.
3. Using ultrasound or fluoroscopy for guidance, a needle is inserted through the skin and directed towards the portal vein.
4. Once the portal vein is accessed, a guide wire is introduced through the needle.
5. The needle is removed, and a catheter is threaded over the guide wire and placed into the portal vein.
6. The catheter can then be used for blood sampling, pressure measurement, or medication administration.
7. The catheter and guide wire are carefully removed, and a small bandage is applied to the insertion site.

Duration

The procedure typically takes 30 to 60 minutes.

Setting

The procedure is usually performed in a hospital's interventional radiology or specialized procedure suite.

Personnel

• Interventional Radiologist or specialized physician
• Radiology technologists
• Nurses
• Anesthesiologist, if sedation beyond local anesthesia is used

Risks and Complications

• Bleeding or hematoma at the insertion site
• Infection
• Injury to surrounding blood vessels or organs
• Thrombosis (clot formation)
• Allergic reaction to contrast dye (if used)
• Possible puncture of the portal vein, leading to internal bleeding

Benefits

• Minimally invasive with a quicker recovery time than surgical options
• Provides crucial diagnostic information
• Directly targets treatment to the liver, enhancing efficacy

Recovery

• Patients are typically monitored for a few hours post-procedure
• Most can go home the same day
• Avoid strenuous activities for 24-48 hours
• Follow-up appointments for any further diagnostic results or assessment

Alternatives

• Magnetic Resonance Imaging (MRI)
• Computed Tomography (CT) scan
• Surgical exploration or biopsy ##### Pros of Percutaneous Portal Vein Catheterization:
• Direct access to the portal vein ##### Cons of Alternatives:
• MRI and CT may not provide direct measurement of portal pressure
• Surgical options are more invasive and carry higher risks

Patient Experience

During the procedure, patients may feel pressure or slight discomfort at the insertion site despite the local anesthesia. Post-procedure, there might be mild soreness or bruising. Pain management usually includes over-the-counter medications and rest.