PORTAL VENOGRAPHY BY SELECTIVE ARTERIAL CATHETERIZATION

¹ Assistant in Radiology, Harvard Medical School and Massachusetts General Hospital
² Instructor in Radiology, Harvard Medical School, and Assistant in Radiology, Massachusetts General Hospital

Arterial methods for visualization of the portal venous system are a practical alternative to conventional direct splenic pulp puncture. Arterial injections are applicable when splenic pulp puncture is contraindicated and consistently produce good opacification. Arterial portography can be performed even in the presence of mild bleeding states, when the spleen is normal or small in size, in infective splenomegaly, when a previous attempt at splenic pulp puncture has been unsuccessful, when a splenoportogram reveals filling only of collaterals, and in patients who have previously undergone splenectomy.

Selective catheterization with injection of the splenic artery is the preferable arterial technique but, if catheterization of this vessel is unsuccessful, selective superior mesenteric artery injection usually produces comparable results. When the spleen has been previously removed, selective superior mesenteric artery injection is the only practical method of showing the portal venous system preoperatively.

Adequate visualization of the portal system was obtained in 85 per cent of 46 patients in whom the arterial technique was used for suspected portal hypertension or thrombosis of the portal vein, or for confirmation of the patency of a previous shunt.

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