CO2 for Wedged Hepatic Venography
Wedged hepatic venography and manometry are frequently used as part of the
angiographic evaluation of patients with cirrhosis and portal hypertension, a transjugular
intrahepatic portosystemic shunt (TIPS) procedure, and transjugular liver biopsy.
Wedged hepatic venous pressure reflects sinusoidal pressure and, in the absence of
portal vein thrombosis, portal pressure. Both iodinated contrast medium and CO2 are
used as contrast agents for wedged hepatic venography. The former provides the infor-
mation about the hepatic morphology and hemodynamics, whereas the latter can better
visualize the portal venous anatomy. The combination of CO2 wedged hepatic venogra-
phy, hepatic manometry, and transjugular liver biopsy represent a “one-stop shopping”
study for the evaluation of the hepatic-portal disorders.