Hepatic venous pressure gradient

Hepatic venous pressure gradient measurement is a safe and minimally invasive method to indirectly measure portal vein pressure in chronic liver disease patients suspected of developing portal vein hypertension. 

This procedure is usually performed at the same time as the transjugular liver biopsy and TIPS procedure.

Indications

• diagnosis of liver fibrosis and risk stratification

• identification of patients with hepatocellular carcinoma who are candidates for liver resection

• monitoring of the efficacy of medical treatment for portal hypertension

• assessment of the progression of portal hypertension

Procedure

The right internal jugular vein is punctured and a sheath is inserted. A catheter and guidewire are navigated into the right hepatic vein. The catheter is exchanged for a balloon-tipped catheter and pressure measurements are taken with and without the balloon inflated, usually three times each. The hepatic venous pressure gradient measurement is then calculated by subtracting the free hepatic venous pressure from the wedged hepatic pressure.

Measurments

• wedged hepatic venous pressure (WHVP)

• free hepatic venous pressure (FHVP)

• IVC pressure

• right atrial pressure

• hepatic venous pressure gradient (HVPG) = WHVP - FHVP

  • HVGP ≥10 mm Hg indicates clinically significant portal hypertension¹

• portal pressure gradient = IVC pressure - portal vein pressure

  • normal values : 0-5 mmHg

  • portal hypertension: 6 - 10 mmHg

  • ≥ 10 mmHg: risk for development of oesophageal varices

  • > 12 mmHg increases ascites risk