It is a radiographic examination of Hepatic veins in which contrast is injected into the IVC via femoral vein to visualize the abnormalities of the hepatic veins.

Indications 

  • Obstruction in hepatic veins
  • To detects the abnormalities in Hepatic vein
  • To evaluate the patency of hepatic vein
  • Formation of a blood clot within the hepatic veins 

Contraindications

  • Hypersensitivity to contrast
  • Blood clotting disorder
  • Suspected pregnancy
  • Impaired renal function 
  • Severe phlebitis
  • Severe hepatic dysfunction

Equipment

  • Fluoroscopy unit with tilting table 
  • Catheter 5F
  • Automatic pressure injector 
  • Contrast
  • Normal Saline
  • Antiseptic solution
  • Femoral vein access needle
  • Guidewire
  • Sheath
  • Gauze 

Patient  preparation

  • The patient should not eat or drink after midnight.
  • Patient KFT reports must be reviewed prior to the examination.
  • Ask patient to stop taking anticoagulant before the exam.
  • Explain the procedure to the patient.
  • Ask the patient to remove clothing and wear hospital gown. 

Procedure

  • Place the patient in supine position on fluoroscopy table.
  • An intravenous line is inserted into the patient arm and sedative medication is given through line to make patient relax.
  • The groin area of the patient must be cleaned with the antiseptic.
  • The local anaesthesia is given at the insertion site of the groin.
  • After numbing the groin area , a vascular access needle is inserted into the femoral vein by using the seldinger technique.
  • When the blood comes out from the needle a flexible guidewire is inserted through the needle. After placing the guidewire the needle is removed then the sheath is placed over the guidewire under the fluoroscopic guidance.
  • The catheter with side holes is inserted into the femoral vein through the sheath.
  • The catheter is smoothly advance through the femoral vein and position inside the iliac vein under the fluoroscopic guidance.
  • The contrast media is injected at the rate of 20ml per second for a total of 40ml into the vein through the catheter.
  • Ask the patient to perform valsalva maneuver for prolonging filling of contrast media in inferior vena cava then the rapid films are taken at the rate of 1 film per second of the abdomen region in AP, oblique positions.
  • After completion of examination the catheter and the sheath is removed and the dressing is applied on the puncture site of the foot.

Aftercare

  • Keep the patient under observation BP, heart rate , injected sites swelling and other vital sign should be the monitored.
  • Plenty of liquid diet is given to the patient to flush out the contrast media from the body.

Interpretation

  • If the venogram shows blood clots or blockage in the veins, the special medicine may be given to dissolve the clot or the ballon angioplasty may be performed.
  • To widen the vessels and improve blood flow during the angioplasty a metal stent may be placed by the surgeons.

Submitted by-

Divya Jha