Wedged hepatic venous pressure recording and venography for the assessment of pre-cirrhotic and cirrhotic liver disease

Abstract

Wedged hepatic venous pressure recording and venography were investigated to assess histologic reflection of the stage of chronic liver disease. Forty-nine patients were studied. The four main groups and the means of the pressure gradients (WHVP - FHVP) with their 95% confidence limits were chronic active hepatitis (n = 12), 6 mm Hg (4.35-7.65); chronic hepatitis in transition to cirrhosis (n = 9), 10.3 mm Hg (6.6-14.1); and established cirrhosis (n = 8), 15.4 mm Hg (9.4-21.4); but only 3.4 mm Hg (2.2-4.6) in near-normal liver (n = 8). A pressure gradient of more than 5 mm Hg was always associated with significant liver disease on liver biopsy. In 25 patients venographies were assessed. Whereas patients with near-normal biopsy specimens had normal appearances, patients with more severe disease showed increasingly severe changes. The techniques applied should not replace liver biopsy. However, they provide relevant supplementary information, might have a place in follow-up studies to assess progression of disease, and occasionally reduce the need for liver biopsy.