On the History of Hepatic Vein Catheterization

Abstract

Hepatic vein catheterization (HVC) in man was first performed 80 years ago in the wake of right-sided heart catheterization. Several new methods, recognitions and concepts followed, especially the indirect Fick-method for determination of splanchnic blood flow. Five years passed before pressure measurements were performed and routine HVCs were done in liver patients. Later came splanchnic kinetics of test substances, dyes, metabolites, hormones and bioactive material and counter current wedged and balloon occlusion pressure. HVC has been a prerequisite for our understanding of the pathogenesis of portal hypertension and variceal bleeding leading to serial measurements, stratification, quantification and treatment of portal hypertension, and transvenous liver biopsy and portosystemic stent insertion (TIPS) followed. Measurements and pathophysiology of formation and amelioration of ascites advanced with HVC, likewise pathophysiology of known and new diseases in other organs, secondary to liver disease (kidney, heart, lung, systemic circulation). The hepatic venous pressure gradient (HVPG, i.e., wedged-to-free hepatic venous pressure) is today considered the gold standard for portal pressure measurement in intrasinusoidal and postsinusoidal portal hypertension. In spite of substantial developments in route, catheter type, pressure measurements and -registration, fluoroscopy, transvascular technique, etc. the basic concepts are the same today. New advanced technology, materials, imaging techniques and IT-power have together with the inborn dynamics of the catheterization given a progressive development, and there are potentials of further refinement and applications in science, clinical physiology, gastroenterology and hepatology.