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Review
. 2018 Jul-Aug;7(4):257-262.
doi: 10.4103/eus.eus_35_18.

EUS-guided portal pressure measurement (with videos)

Jason B Samarasena  1 , Allen R Yu  1 , Kenneth J Chang  1
Affiliations
Review

EUS-guided portal pressure measurement (with videos)

Jason B Samarasena et al. Endosc Ultrasound. 2018 Jul-Aug.

Abstract

A growing number of studies have explored EUS-guided vascular catheterization due to the relative proximity of the gastrointestinal tract to the major blood vessels of the mediastinum and abdomen. In particular, EUS-guided access of the portal vein (PV) may be favorable given the relative difficulty of PV access through standard percutaneous routes. Two major diagnostic applications of EUS-guided vascular access include angiography and assessment of intravascular pressure. This review will outline the different devices and techniques employed to obtain angiographic visualization and/or direct pressure measurements of the portal circulation. Ease of access, safety, and important lessons learned from each approach will be highlighted.

Keywords: EUS; hepatic venous portal gradient; portal vein angiography; portal vein manometry; portal venous pressure.

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Conflict of interest statement

There are no conflicts of interest

Figures

Figure 1
Figure 1
Compact manometer used for EUS-guided portal pressure measurement (Cook Medical, Bloomington, IN)
Figure 2
Figure 2
EUS-guided portal pressure measurement apparatus showing noncompressible tubing attached to the FNA needle inlet (right pane) and compact manometer being placed at the midaxillary line of the patient (left pane)
Figure 3
Figure 3
EUS image of needle puncture of middle hepatic vein with 25G FNA needle (a – ultrasound image; b – diagram)
Figure 4
Figure 4
EUS Doppler flow image of middle hepatic vein demonstrating multiphasic waveform
Figure 5
Figure 5
EUS image of needle puncture of left portal vein with 25G FNA needle (a – ultrasound image; b – diagram)
Figure 6
Figure 6
EUS Doppler flow image of left portal vein demonstrating typical waveform
See this image and copyright information in PMC

References

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