Interventions for Portal Hypertension: Hepatic Vein Pressure Gradient and Trans Jugular Liver Biopsy

  • Vinu Moses
  • Shyamkumar N. Keshava


Hepatic vein pressure gradient (HVPG) measurement for the quantification of portal hypertension is considered the gold standard for the measurement of portal pressure. It is defined as the difference in pressures between the occluded and free hepatic vein. The pressure in the occluded hepatic vein represents the hepatic sinusoidal pressure, which is slightly lower than the portal pressure. This difference in pressure is however clinically insignificant. Measurement of the HPVG is used to quantify the degree of portal hypertension in chronic liver disease. Normal HPVG values are between 1 to 5 mmHg. Higher pressures are considered to represent portal hypertension. Pressures greater than 10 mmHg represent clinically significant hypertension, while pressures above 12 mmHg increase the risk of variceal rupture [1, 2].


  1. 1.
    Abraldes JG, Sarlieve P, Tandon P. Measurement of portal pressure. Clin Liver Dis. 2014 Nov;18(4):779–92.CrossRefGoogle Scholar
  2. 2.
    Kumar A, Sharma P, Sarin SK. Hepatic venous pressure gradient measurement: time to learn! Indian J Gastroenterol. 2008 Apr;27(2):74–80.PubMedGoogle Scholar
  3. 3.
    Procopeţ B, Tantau M, Bureau C. Are there any alternative methods to hepatic venous pressure gradient in portal hypertension assessment? J Gastrointestin Liver Dis. 2013 Mar;22(1):73–8.PubMedGoogle Scholar
  4. 4.
    Reiberger T, Ulbrich G, Ferlitsch A, et al. Carvedilol for primary prophylaxis of variceal bleeding in cirrhotic patients with hemodynamic non-response to propranolol. Hepatology. 2012;56(S1):272A–3A.Google Scholar
  5. 5.
    Lovet JM, Bruix J, Fuster J, et al. Liver transplantation for small hepatocellular carcinoma: the tumor-node-metastasis classification does not have prognosis power. Hepatology. 1998;27:1572–7.CrossRefGoogle Scholar
  6. 6.
    Woolfson J, John P, Kamath B, Ng VL, Ling SC. Measurement of hepatic venous pressure gradient is feasible and safe in children. J Pediatr Gastroenterol Nutr. 2013 Nov;57(5):634–7.CrossRefGoogle Scholar
  7. 7.
    Stift J, Semmler G, Walzel C, Mandorfer M, Schwarzer R, Schwabl P, et al. Transjugular aspiration liver biopsy performed by hepatologists trained in HVPG measurements is safe and provides important diagnostic information. Dig Liver Dis. 2019 Aug;51(8):1144–51.CrossRefGoogle Scholar
  8. 8.
    Chelliah ST, Keshava SN, Moses V, Surendrababu NRS, Zachariah UG, Eapen CE. Measurement of hepatic venous pressure gradient revisited: catheter wedge vs balloon wedge techniques. Indian J Radiol Imaging. 2011;21:291–3.CrossRefGoogle Scholar
  9. 9.
    Karagiannakis DS, Voulgaris T, Siakavellas SI, Papatheodoridis GV, Vlachogiannakos J. Evaluation of portal hypertension in the cirrhotic patient: hepatic vein pressure gradient and beyond. Scand J Gastroenterol. 2018 Nov;53(10–11):1153–64.CrossRefGoogle Scholar
  10. 10.
    Elkrief L, Rautou PE, Ronot M, et al. Prospective comparison of spleen and liver stiffness by using shear-wave and transient elastography for detection of portal hypertension in cirrhosis. Radiology. 2015;275:589–98.CrossRefGoogle Scholar
  11. 11.
    Ma X, Wang L, Wu H, et al. Spleen stiffness is superior to liver stiffness for predicting esophageal varices in chronic liver disease: a meta-analysis. PLoS One. 2016;11:e0165786.CrossRefGoogle Scholar
  12. 12.
    Yin M, Glaser KJ, Manduca A, Mounajjed T, Malhi H, Simonetto DA, et al. Distinguishing between hepatic inflammation and fibrosis with MR Elastography. Radiology. 2017;284(3):694–705.CrossRefGoogle Scholar
  13. 13.
    Petitclerc L, Sebastiani G, Gilbert G, Cloutier G, Tang A. Liver fibrosis: review of current imaging and MRI quantification techniques. J Magn Reson Imaging. 2017;45(5):1276–95.CrossRefGoogle Scholar
  14. 14.
    Mammen T, Keshava SN, Eapen CE, Raghuram L, Moses V, Gopi K, et al. Transjugular liver biopsy: a retrospective analysis of 601 cases. J Vasc Interv Radiol. 2008 Mar;19(3):351–8.CrossRefGoogle Scholar
  15. 15.
    Keshava SN, Mammen T, Surendrababu N, Moses V. Transjugular liver biopsy: what to do and what not to do. Indian J Radiol Imaging. 2008 Aug;18(3):245–8.CrossRefGoogle Scholar
  16. 16.
    Dohan A, Guerrache Y, Dautry R, Boudiaf M, Ledref O, Sirol M, et al. Major complications due to transjugular liver biopsy: incidence, management and outcome. Diagn Interv Imaging. 2015 Jun;96(6):571–7.CrossRefGoogle Scholar
  17. 17.
    Cholongitas E, Quaglia A, Samonakis D, Senzolo M, Triantos C, Patch D, et al. Transjugular liver biopsy: how good is it for accurate histological interpretation? Gut. 2006 Dec;55(12):1789–94.CrossRefGoogle Scholar
  18. 18.
    Moses V, Keshava SN, Mammen S, Ahmed M, Eapen CE, Ramakrishna B. Trans-caval trans-jugular liver biopsy--a technical modification of trans-jugular liver biopsy. Br J Radiol. 2014 Nov;87(1043):20140327.CrossRefGoogle Scholar
  19. 19.
    Khosa F, McNulty JG, Hickey N, O’Brien P, Tobin A, Noonan N, et al. Transvenous liver biopsy via the femoral vein. Clin Radiol. 2003 Jun;58(6):487–91.CrossRefGoogle Scholar
  20. 20.
    Atar E, Ben Ari Z, Bachar GN, Amlinski Y, Neyman C, Knizhnik M, et al. A comparison of transjugular and plugged-percutaneous liver biopsy in patients with contraindications to ordinary percutaneous liver biopsy and an “in-house” protocol for selecting the procedure of choice. Cardiovasc Intervent Radiol. 2010 Jun;33(3):560–4.CrossRefGoogle Scholar
  21. 21.
    Tsang WK, Luk WH, Lo AXN. Ultrasound-guided plugged percutaneous biopsy of solid organs in patients with bleeding tendencies. Hong Kong Med J. 2014 Apr;20(2):107–12.PubMedGoogle Scholar

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© Springer Nature Singapore Pte Ltd. 2021

Authors and Affiliations

  • Vinu Moses
    • 1
  • Shyamkumar N. Keshava
    • 1
  1. 1.Department of RadiologyChristian Medical College HospitalVelloreIndia

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