Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
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DOI：
10.3791/58819
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发表时间：
2020-06-01
影响因子：
1.2
通讯作者：
Mandorfer, Mattias
中科院分区：
文献类型：
--
作者：
Reiberger, Thomas;Schwabl, Philipp;Mandorfer, Mattias
在这里，我们提供了详细的方案，描述了晚期慢性肝病患者肝静脉压力梯度（HVPG）测量的临床程序，然后是经颈静脉活检的指导。在局部麻醉和超声引导下，将导管导引器鞘置于右颈内静脉中。使用荧光镜引导，将球囊导管推进到下腔静脉 (IVC) 并插入大肝静脉。当球囊阻塞插管肝静脉的流出时，通过注射造影剂来确保导管的正确和足够的楔形位置。校准外部压力传感器后，通过楔形肝静脉压 (WHVP) 和自由肝静脉压 (FHVP) 的三次重复记录获得连续压力记录。 FHVP 和 WHVP 之间的差异称为 HVPG，其值 >= 10 mm Hg 表明有临床意义的门静脉高压 (CSPH)。在拔除导管之前，记录在同一水平的下腔静脉中获得的压力读数以及右心房压力。最后，可以通过相同的血管途径获得经颈静脉肝活检。有不同的系统可供选择；然而，核心活检针优于抽吸针，特别是对于肝硬化肝脏。再次，在荧光镜引导下，将活检针导引器鞘推进到肝静脉中。接下来，经颈静脉活检针轻轻地穿过导引器鞘：（i）在抽吸活检的情况下，针在抽吸下被推进到肝实质中，然后快速取出，或（ii）在核心活检的情况下，切割机构在实质内触发。可以安全地进行几次单独的传代，以通过经颈静脉活检获得足够的肝脏标本。对于经验丰富的人来说，这些程序的结合大约需要 30-45 分钟。
Here we provide a detailed protocol describing the clinical procedure of hepatic venous pressure gradient (HVPG) measurement in patients with advanced chronic liver disease followed by an instruction for transjugular biopsy. Under local anesthesia and ultrasound guidance, a catheter introducer sheath is placed in the right internal jugular vein. Using fluoroscopic guidance, a balloon catheter is advanced into the inferior vena cava (IVC) and inserted into a large hepatic vein. Correct and sufficient wedge position of the catheter is ensured by injecting contrast media while the balloon is blocking the outflow of the cannulated hepatic vein. After calibrating the external pressure transducer, continuous pressure recordings are obtained with triplicate recordings of the wedged hepatic venous pressure (WHVP) and free hepatic venous pressure (FHVP). The difference between FHVP and WHVP is referred to as HVPG, with values >= 10 mm Hg indicating clinically significant portal hypertension (CSPH). Before removing the catheter, pressure readings obtained in the IVC at the same level, as well as the right atrial pressure are recorded.Finally, a transjugular liver biopsy can be obtained via the same vascular route. Different systems are available; however, core biopsy needles are preferred over aspiration needles, especially for cirrhotic livers. Again, under fluoroscopic guidance a biopsy needle introducer sheath is advanced into an hepatic vein. Next, the transjugular biopsy needle is gently advanced through the introducer sheath: (i) in case of aspiration biopsy, the needle is advanced into the liver parenchyma under aspiration and then removed quickly, or (ii) in case of a core biopsy, the cutting-mechanism is triggered inside the parenchyma. Several separate passages can be safely performed to obtain sufficient liver specimens via transjugular biopsy. In experienced hands, the combination of these procedures takes about 30-45 min.