Abstract
Background: Portal vein (PV) pressure measurements can provide valuable clinical information for management of patients with liver disease and portal hypertension. Aim: To assess the feasibility of EUS-guided PV catheterization and pressure measurements in a porcine model. Methods: We performed acute and survival experiments on 50-kg pigs under general anesthesia. Intrahepatic branch of PV, was identified with linear array endoscopic ultrasound (EUS). PV puncture was performed using a 19 gauge fine needle aspiration (FNA) needle. A 0.035 inch guide wire was advanced through the needle into the PV under fluoroscopic and EUS guidance. The FNA needle was withdrawn over the wire and exchanged to a modified 5.5 Fr ERCP catheter. The catheter was advanced into the PV and.connected to a continuous pressure monitor. Iodinated contrast was injected through the catheter to confirm catheter position and to study PV anatomy. Continuous PV pressure measurements were obtained for a duration of 1 hour. Afterwards the catheter was removed, the animals were observed for 30 minutes and 3 animals were sacrificed for necropsy. The other 2 animals were survived for 2 weeks and then sacrificed. Results: We completed 5 animal experiments. PV catheterization, angiography and pressure measurement were performed in all animals without any problems or complications. Angiography through the catheter demonstrated good opacification of PV and its branches. The measurements demonstrated consistent results with minimal variability. There was no change in vital signs or hemodynamic parameters during PV catheterizations, angiography, pressure measurements and catheter removal in all animals. Survival experiments did not reveal any changes in animal condition, vital signs, behavior and eating habits post procedure. Postmortem examination in all animals revealed no active bleeding, or damage to the liver, other intraabdominal organs or blood vessels. Conclusions: EUS-guided PV catheterization is feasible, safe and can be used for portal anigiography and pressure measurements.
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