Percutaneous transhepatic portography without hemodynamic evaluation, radiological supervision and interpretation
CPT4 code
Name of the Procedure:
Percutaneous Transhepatic Portography (PTP) Common name(s): Percutaneous Transhepatic Portography
Summary
Percutaneous Transhepatic Portography (PTP) is a minimally invasive imaging procedure performed to visualize the portal venous system. This procedure involves inserting a thin needle through the skin into the liver to inject a contrast dye and take X-ray images of the veins that carry blood from the digestive organs to the liver.
Purpose
PTP is used to diagnose and evaluate conditions affecting the portal venous system, such as blockages or abnormalities in blood flow. The primary goal is to provide a clear image of the blood vessels so that accurate diagnoses can be made without the need for surgical intervention.
Indications
This procedure is indicated for patients who:
- Suspect portal vein thrombosis
- Suspect liver tumors or abnormalities
- Have unexplained gastrointestinal bleeding
- Need evaluation for liver transplant suitability
- Monitor the status of previous liver interventions
Preparation
- Patients are usually asked to fast for at least 6-8 hours before the procedure.
- Blood tests, including clotting profiles, may be required to assess the patient's readiness.
- Patients should inform their healthcare provider about any medications they are taking, as some medications might need to be paused or adjusted.
Procedure Description
- The patient is positioned, usually lying flat on their back.
- Local anesthesia is administered to numb the area where the needle will be inserted.
- A thin needle is carefully inserted through the skin and into the liver.
- Contrast dye is then injected through the needle to highlight the portal vein system.
- X-ray images are taken to visualize the veins and assess for any abnormalities.
- Once imaging is completed, the needle is removed, and a small bandage is applied to the insertion site.
Duration
The procedure typically takes about 30-60 minutes to complete.
Setting
PTP is usually performed in a hospital's radiology department or an outpatient imaging center equipped with the necessary imaging technology.
Personnel
- Interventional Radiologist
- Radiologic Technologist
- Registered Nurse for monitoring and patient support
Risks and Complications
- Infection at the needle insertion site
- Bleeding or bruising
- Allergic reaction to the contrast dye
- Injury to nearby organs or blood vessels
- Very rarely, liver damage
Benefits
- Provides detailed images of the portal venous system
- Helps in accurate diagnosis of portal vein conditions
- Minimally invasive with a faster recovery time compared to surgical methods
Recovery
- Patients are typically monitored for a few hours after the procedure.
- Mild discomfort at the insertion site is common and can be treated with over-the-counter pain medications.
- Patients should avoid strenuous activities for a few days.
- A follow-up appointment may be scheduled to discuss the results.
Alternatives
- Doppler Ultrasound: Non-invasive but may not provide as detailed images.
- CT or MRI Angiography: More comprehensive imaging but involves more radiation or extended imaging time.
- Surgical exploration: More invasive with longer recovery times.
Patient Experience
- Patients may feel a slight pinch or pressure when the needle is inserted.
- There might be a sensation of warmth as the contrast dye is injected.
- Post-procedure, mild soreness at the insertion site is common.
- Pain management is typically straightforward with mild pain relievers.