The transjugular route: The key hole to the liver world

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Digestive and Liver Disease

February 2007,

Pages 105-116

The transjugular route: The key hole

to the liver world

M. Senzolo, P. Burra, E. Cholongitas, F. Lodato, L. Marelli, P. Manousou, D. Patch, G.C. Sturniolo

& A.K. Burroughs

Liver Transplantation & Hepatobiliary

Unit, Royal Free Hospital, London, UK

Gastroenterology, University-Hospital of Padova,

Padova, Italy

Department of Gastroenterology, University

of Crete, Heraklion, Greece

Abstract

Portal

hypertensive complications are major causes of morbidity and mortality in

patients with liver cirrhosis. The advent of the

transjugular route with its minimal access allows non-surgical management of

portal hypertension, therapy of venous complications of liver transplantation,

monitoring of therapy for portal hypertension, hepatic venous pressure gradient

and is also the major route to treat hepatic venous obstruction syndromes. In addition, the transjugular route is a safe route to

perform a liver biopsy (transjugular liver biopsy) and allows retrograde

evaluation of the portal vein. All these procedures

can be combined in the same session.

These

hepatic interventional radiological skills should be incorporated into the

expertise of the liver team in specialised hepatological centres, particularly

in liver transplant centres as they are especially

useful in improving outcomes of cirrhotic patients on the liver transplantation

waiting list. A limitation in achieving this goal,

could be the number of experienced radiologists, but hepatologists

can be trained, at least for the most simple procedures (transjugular liver

biopsy and hepatic venous pressure gradient). This

would allow wider applicability and use of these diagnostic and therapeutic

techniques, all through a 2 mm hole in the

neck—the key hole to the liver world.

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