Umbilical Vein Angiography

Abstract

Radiographic visualization of the portal venous system by splenoportography has proved worthwhile in the evaluation of patients with portal hypertension. This technie, however, has serious technical limitations, is hazardous, and is frequently contraindicated in patients to whom it might be of great value. Furthermore, the hepatogram phase has been found disappointing when used to visualize space-occupying hepatic lesions. To overcome the disadvantages of splenoportography, we have approached the portal venous system through the umbilical vein remnant (1). This communication illustrates the superb radiographic quality of portal venography as performed through the umbilical vein and demonstrates the unique usefulness of this technic for the visualization of space-occupying hepatic lesions. Examples chosen from 60 umbilical vein catheterizations are presented. Method Umbilical vein portograms and hepatograms were obtained in patients with cirrhosis of the liver and/or suspected portal hypertension and in those patients with space-occupying lesions of the liver. A small midline incision is made in the epigastrium and carried down through the linea alba. The umbilical vein remnant is found extraperitoneally in the free edge of the falciform ligament. The vein remnant is opened and dilated down to the point where it enters the portal venous system within the porta hepatis, and a catheter is inserted. In patients with cirrhosis, the portal pressure is measured and portograms obtained with a rapid film-changer. The injection of the contrast material (30 cc 50 per cent Hypaque) is rapid, requiring only one to two seconds at 125 pounds per square inch. Demonstration of the portal venous system, including the hepatogram phase, requires exposure of one film per second for ten to twelve seconds. The catheter is then removed, and the incision closed. In patients with metastatic or primary carcinoma of the liver, the wound is closed and the catheter left in situ for serial hepatograms. The catheter is kept open by a slow intravenous drip. After a course of chemotherapy, the catheter is clamped and gradually removed over a period of several hours. Results The angiograms obtained by this method are of excellent quality. In patients with cirrhosis and portal hypertension, the contrast medium refluxes into the extrahepatic portal vein and occasionally into splenic, mesenteric, and esophageal collaterals (Fig. 1). In patients without portal hypertension, the contrast agent rarely enters the extrahepatic portal vein but progresses cephalad through the liver, revealing a detailed outline of the intrahepatic portal venous system. During the sinusoidal phase, there is marked opacification of the liver (Fig. 2). Space-occupying lesions are shown as radiolucent areas (Fig. 3), and those as small as 0.5 cm in diameter can be accurately measured with this technic.