EUS-guided portal vein catheterization: a promising novel approach for portal angiography and portal vein pressure measurements

Background: Portal vein (PV) pressure measurements can provide valuable information for the management of patients with liver disease and portal hypertension. Objective: To evaluate the feasibility and the safety of EUS-guided PV catheterization and pressure measurements in a porcine model. Setting: Acute and survival experiments on five 50-kg pigs. Design and Interventions: Intrahepatic PV was punctured under EUS guidance by using a 19-gauge FNA needle. A 0.035-inch guidewire was advanced through the needle into the PV The needle was withdrawn. A 5-517 ERCP catheter was advanced over the guidewire into the PV and then connected to a pressure monitor. Continuous PV measurements were obtained for an hour. Afterward, the catheter was removed, and the animals were observed for 30 minutes. Three animals were then immediately euthanized for a necropsy. The other two animals were observed for two weeks and then were euthanized. Main Outcome Measurements: The ability to perform EUS-guided PV catheterization and pressure measurement without complications. Results: PV catheterization, angiography, and pressure measurements were performed without any problems or complications. There were no changes in vital signs and hemodynamic parameters during PV catheterizations, angiography, pressure measurements, and catheter removal. Survival experiments did not demonstrate any change in animal condition, behavior, or eating habits after the procedure. A necropsy in all animals revealed no active bleeding, and no damage to the liver, other intra-abdominal organs, or blood vessels. Limitations: No validation of measured PV pressure was made. Conclusions: EUS-guided PV catheterization is feasible, safe, and can be used for portal angiography and pressure measurements.