Name of the Procedure:

Hepatic Venography, Wedged or Free, with Hemodynamic Evaluation, Radiological Supervision, and Interpretation

Summary

Hepatic venography is a diagnostic imaging procedure that evaluates the veins of the liver. It involves injecting contrast dye into the liver's veins to visualize blood flow and measure pressures within these vessels, using X-ray imaging for supervision and interpretation.

Purpose

The procedure diagnoses and assesses various liver conditions, including portal hypertension, hepatic vein thrombosis, and other vascular abnormalities. The goal is to obtain detailed information about blood flow and pressure within the liver's veins to guide treatment decisions.

Indications

• Symptoms of portal hypertension (e.g., ascites, variceal bleeding)
• Suspected hepatic vein thrombosis
• Unexplained liver dysfunction
• Pre-surgical evaluation for liver transplant or other liver surgeries

Preparation

• The patient may need to fast for 4-6 hours before the procedure.
• Medication adjustments may be required, especially anticoagulants.
• Baseline blood tests, including liver function tests and coagulation profile, are typically performed.
• Allergies to contrast dye should be communicated to the medical team.

Procedure Description

1. The patient is positioned on a fluoroscopy table.
2. Local anesthesia is administered at the insertion site, usually in the neck or groin.
3. A catheter is inserted into a large vein and guided to the liver's veins.
4. Contrast dye is injected, and X-ray images are captured.
5. Measurements of blood pressure in the hepatic veins are taken (hemodynamic evaluation).
6. The catheter is then removed, and the insertion site is bandaged.

Tools: Catheter, contrast dye, fluoroscopy machine.

Anesthesia: Local anesthesia is commonly used, with sedation if necessary.

Duration

The procedure typically takes between 60 to 90 minutes.

Setting

Hepatic venography is performed in a hospital's radiology or interventional radiology department.

Personnel

• Interventional Radiologist
• Radiologic Technologist
• Nurses
• Anesthesiologist (if sedation is used)

Risks and Complications

• Allergic reaction to contrast dye
• Bleeding or bruising at the insertion site
• Infection
• Rarely, vein damage or thrombosis

Benefits

• Precise diagnosis of liver vascular conditions
• Helps in planning treatment strategies
• Facilitates accurate assessment before liver surgeries

Recovery

• Patients are usually monitored for a few hours post-procedure.
• Instructions include avoiding heavy lifting and strenuous activities for 24-48 hours.
• Follow-up appointments might be necessary to discuss results and further management.

Alternatives

• Non-invasive imaging (e.g., Doppler ultrasound, MRI)
• Liver biopsy, if tissue diagnosis is needed

Pros and Cons: Non-invasive imaging avoids the risks of catheter insertion but may not provide as detailed hemodynamic information.

Patient Experience

During the procedure, patients might feel a slight pressure or discomfort from the catheter insertion. Post-procedure, mild pain or bruising at the site is common and can be managed with pain relievers. Most patients can resume normal activities within a day or two.