| Abstract: | Portal hypertension resulting in ascites and portosystemic shunts leading to hepatoencephalopathy are major clinical manifestations of hepatic circulatory disease. Diffuse liver disease impairing sinusoidal blood flow can induce portal hypertension, portosystemic shunts, or both. The liver may also be involved secondarily in posthepatic hypertension and become the site of ascitic fluid formation. Portosystemic shunts may or may not be associated with portal hypertension. Selective catheterization of the hepatic and portal veins permits one to record pressures and to outline gross and subgross vascular anomalies by injecting contrast medium. Sequential pressure recordings in the caudal vena cava, in a free and wedged hepatic vein position, in the splenic pulp, and directly in the portal vein are the bases for the differentiation of prehepatic, liver-induced, and posthepatic portal hypertension. In addition to localizing the disease process along the postcaval-portal vein axis, pressure measurements are a reliable basis for the prognosis and selection of the most appropriate therapy. In dogs with portacaval shunts, wedge hepatic vein pressure recordings assist in the detection of hepatic sinusoidal anomalies that limit blood flow and preclude surgical ablation of the shunts. The various technics and their suitability for direct and indirect portal vein pressure recording are described and evaluated. Normal portal vein pressure values in 11 dogs and two cats, using different technics, are provided. The clinical usefulness of the various technics of pressure recording and angiography was illustrated in ten dogs with ascites, hepatoencephalopathy, or both. |
