Portal hypertension

Definition

Hepatic veinous pressure gradient (HVPG)

HVPG = wedged hepatic vein pressure - free hepatic vein pressure

  • standard way of assessing sinusoidal or post-sinusoidal portal HTN
  • concept
    • occluding a hepatic vein with a balloon essentially transforms the occluded vein segment into a large hepatic sinusoid, where hepatic blood flow (combination of portal venous and hepatic arterial) pools. Thus, measurement from within the occluded vein is equivalent to hepatic sinusoidal pressure
    • the difference between hepatic sinusoidal pressure and hepatic venous pressure indicates how much resistance to blood flow exists at the level of the hepatic sinusoids
    • note: right atrial pressure, commonly used as a gauge of systemic venous pressure, is not used
Prognostication by pressure measurements[1]
Category HVPG Absolute (wedge pressure) Associations
Normal 1-5 mmHg
Portal HTN * 6-9 mmHg >12 mmHg
"Clinically significant"

Portal HTN

≥10 mmHg variceal bleeding
Target after TIPS <12 mmHg

* HPVG 6-9 mmHg considered "subclinical" portal HTN, with minimal risk for variceal bleeding, ascites, hepatorenal syndrome

Treatment

TIPS or BRTO can be performed for portal hypertension related complications.

  1. Berzigotti A, Seijo S, Reverter E, Bosch J. Assessing portal hypertension in liver diseases. (2013) Expert review of gastroenterology & hepatology. 7 (2): 141-55. doi:10.1586/egh.12.83 - Pubmed

Contributing Authors

Kevin Liu