COMPLICATIONS OF PERCUTANEOUS TRANSHEPATIC CATHETERIZATION OF THE PORTAL VENOUS SYSTEM IN PATIENTS WITH PORTAL-HYPERTENSION

We report here complications of percutaneous transhepatic catheterizat ion of the portal venous system in 170 Japanese patients with portal h ypertension. All patients underwent percutaneous transhepatic portogra phy and percutaneous transhepatic obliteration of oesophagogastric var ices was also performed in 29 patients. After retraction of the cathet er, the puncture canal was plugged with gelatin sponge in 150 subjects and with one steel coil in 20 others. The overall complication rate w as 16.5%. Intraperitoneal bleeding occurred in 10.6% of patients and 2 .9% required blood transfusion. In these patients with intraperitoneal bleeding, the gelatin sponge was used for plugging after retraction o f the catheter, while in the 20 patients with a steel coil plug, haemo peritoneum never occurred. Right pleural effusion was recognized in 3. 5% of patients, intraperitoneal bile leakage in 1.8% and deterioration of liver function due to arteriovenous fistula in 0.6%. By univariate and multivariate analyses, female gender was the only risk factor for intraperitoneal bleeding among 150 patients investigated by percutane ous transhepatic catheterization of the portal venous system with gela tin sponge plugging. Intraperitoneal bleeding is the most important co mplication in patients with portal hypertension; it is difficult to pr edict intraperitoneal bleeding before retraction of the catheter in pa tients for whom gelatin sponge is used. Thus, for patients undergoing percutaneous transhepatic catheterization of the portal venous system, close follow up is recommended.