Purpose: To evaluate the consistency and agreement between portal venous pressure measured by fine-needle (F), portal vein catheterization (D), and hepatic vein balloon-occlusion (W) in decompensated cirrhotic patients with intrahepatic venovenous shunts (IHVS).
Materials and methods: 156 consecutive patients planning to receive transjugular intrahepatic portosystemic shunt in our center were screened for study participation. The F/D/W were assessed for consistency by Pearson coefficient (r), linear regression coefficient (R2), and intraclass correlation coefficient (ICC), and for disagreement (error exceeding 20% of D) by Bland-Altman method.
Results: Of 92 eligible patients, F was successfully obtained in 37 (40.2%) with IHVS, with no puncture-related complications. In these patients, there were significant differences between W/D (-14.3 mmHg, p<0.001) with poor consistency (r=0.410, R2=0.168, ICC=0.105), but only minor differences between F/D (-0.5 mmHg, p=0.134) with good consistency (r=0.951, R2=0.904, ICC=0.944). This pattern did not alter when their pressure gradients were compared (R2=0.083/0.767) and adjusted by stiffness measurements and platelet counts (R2=0.196/0.789). The W/D and F/D disagreement occurred in 47.8% (34 with IHVS, 91.9%) and 0.0% of patients, respectively. In multivariate linear regression, only the presence of portal vein thrombosis (p=0.045) was an independent predictor for the lower F/D ratio. Portosystemic pressure gradient of F showed greater ability to stratify that of D of 16 (AUC: 1.000 vs. 0.574, p<0.001) and 20 (0.974 vs.0.662, p=0.001) mmHg than that of W.
Conclusion: Fine-needle portal venous pressure measurement could be a valid and safe approach to reflect the severity of sinusoidal portal hypertension in patients with IHVS.
Keywords: Chronic liver disease; Decompensated cirrhosis; Digital subtraction angiography; Hepatic vein; Portal vein.
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