Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation
CPT4 code
Name of the Procedure:
Percutaneous Transhepatic Portography with Hemodynamic Evaluation, Radiological Supervision, and Interpretation
Summary
Percutaneous transhepatic portography is a minimally invasive medical procedure that involves inserting a needle through the skin and into the liver to visualize the portal vein system using X-rays. Hemodynamic evaluation assesses the blood flow within these veins. Radiological supervision and interpretation ensure accurate image analysis and diagnosis.
Purpose
This procedure addresses various liver and portal vein conditions, such as portal hypertension (high blood pressure in the liver's portal vein system) or to investigate unexplained gastrointestinal bleeding. The goals are to obtain detailed images of the portal venous system, assess blood flow dynamics, and guide further treatment based on the findings.
Indications
- Portal hypertension
- Unexplained gastrointestinal bleeding
- Liver cirrhosis
- Suspected portal vein thrombosis
- Pre-transplant liver evaluation
Preparation
- The patient may need to fast for at least 6 hours before the procedure.
- Certain medications, especially blood thinners, may need to be adjusted or discontinued.
- Blood tests, including clotting profiles and liver function tests, may be required.
- Pre-procedure imaging such as ultrasound or CT scan of the abdomen might be done.
Procedure Description
- The patient is positioned on the examination table, with the liver area sterilized.
- Local anesthesia is administered to numb the skin and tissue around the insertion site.
- A small needle is inserted through the skin into the liver, guided by real-time imaging such as ultrasound.
- Contrast dye is injected into the portal vein system to make the veins visible on X-ray images.
- Hemodynamic measurements, such as pressures within the portal veins, are taken.
- Radiological images are captured, interpreted, and analyzed by a radiologist.
- The needle is removed, and pressure is applied to the insertion site to prevent bleeding.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
This procedure is performed in a hospital setting, specifically in an interventional radiology suite.
Personnel
- Interventional Radiologist
- Radiologic Technologist
- Nurse
Anesthesiologist (if sedation or general anesthesia is used)
Risks and Complications
- Common risks: bleeding, infection, pain at the insertion site.
- Rare risks: liver injury, puncture of nearby organs, or adverse reactions to the contrast dye.
- Management: immediate medical attention and monitoring are provided for any complications.
Benefits
- Provides detailed images of the portal vein system.
- Helps in diagnosing conditions that non-invasive tests may not detect.
- Can guide further therapeutic decisions.
- Results and benefits are usually realized soon after the procedure.
Recovery
- Post-procedure monitoring for a few hours to ensure no immediate complications.
- The insertion site should be kept clean and dry.
- Light activity is generally resumed within 24 hours, but heavy lifting and strenuous activities should be avoided for a few days.
- Follow-up appointments to discuss the results and next steps.
Alternatives
- Doppler Ultrasound: Non-invasive but less detailed imaging.
- CT or MRI Angiography: Non-invasive and provides good imaging but without hemodynamic evaluation.
- Direct measurement during surgery: More invasive and generally reserved for specific cases.
Patient Experience
- Local or general anesthesia will prevent pain during the procedure.
- Mild discomfort or pressure sensation might be experienced.
- Some soreness at the insertion site post-procedure.
- Instructions provided for pain management and comfort measures post-procedure.