Portal Venography

Early in 1948, a series of experiments was initiated in the Department of Surgical Research of the New York Hospital-Cornell Medical Center, with the ultimate purpose of determining whether the portal vein in man could be resected were it found to be invaded by a malignant tumor. Because, in contradistinction to the common laboratory animals, the anatomical relationships of this vessel in the Macaca mulatta monkey are almost identical with those of man, this animal was chosen for these studies. Within a few months, it was demonstrated that in the majority of instances sudden and complete occlusion of the portal vein of this monkey could be successfully accomplished. Emboldened by these animal experiments, the authors deliberately ligated the portal vein in two human beings suffering from inoperable gastric cancer. These patients ultimately died of their malignant neoplasms, but no untoward effects were noted which could be ascribed to the sudden and complete occlusion of their portal veins. The details of these experiments have been reported elsewhere (1–3). Relatively soon after these studies were begun, it became apparent that evaluation of the circulatory changes produced was unsatisfactory if the conventional methods of investigation were employed. Exploratory celiotomy, autopsy, and latex or metallic mass injections proved equally inadequate. The more dynamic technic of roentgen angiography after the injection of diodrast was, therefore, applied to this circulatory system and designated portal venography (1–3). This method of studying circulatory changes in the portal venous system has proved pre-eminently satisfactory both in the experimental animal and in man. It is the purpose of the present report to describe our experiences with this form of venous angiography and to comment upon its possible usefulness as a diagnostic procedure. Only three other articles dealing with portal venography have been found. Fariñas (4), in 1947, published a venogram obtained after injecting diodrast into the saphenous vein of a patient who had apparently had a portacaval shunt performed for portal hypertension. Fariñas believed he demonstrated the portal vein and the liver. Blakemore (5) injected the same contrast medium into the coronary vein. He commented as follows: “Venography following the injection of…Diodrast in a branch of the coronary vein is useful in confirming the site of origin of the coronary vein.” In 1950, Moore and Bridenbaugh (6) described their technic for visualizing the intrahepatic portal system and indicated that the practical applications of portal venography remained to be determined. Preliminary Animal Experiments Portal venography has been performed in over 30 Macaca mulatta monkeys weighing from 10 to 20 pounds. In those animals in which the portal system has been injected rapidly with from 15 to 25 milliliters of 35 per cent diodrast, there have been no fatalities.