Multicenter analysis on the correlation between the anatomical characteristics of hepatic veins and hepatic venous wedge pressure.

Background: Wedged hepatic venous pressure (WHVP) is a crucial variable for accurately assessing the hepatic venous pressure gradient (HVPG) and is vital for the diagnosis and prognostic evaluation of patients with portal hypertension (PH).

Aim: To investigate the anatomical characteristics of balloon-occluded hepatic venous angiography in patients with PH and analyze the relationship between the WHVP and portal venous pressure (PVP).

Methods: This retrospective study included 877 patients with PH who met the inclusion criteria from January 2020 to June 2024. Routine and innovative hepatic venous angiography was performed during transjugular intrahepatic portosystemic shunt procedures to measure hepatic venous and PVPs. All patients' angiographic images were collected for analysis. The associations between WHVP and PVP in each group were analyzed linear regression analysis, and a predictive model was established.

Results: The 877 patients had a mean age of 52.6 ± 13.0 years, with 582 males and 295 females. Patients were categorized into four groups on the basis of their anatomical structure. All groups showed strong correlations between WHVP and PVP. The regression coefficient between the WHVP and PVP in the hepatic right vein-portal venous angiography group was 0.884 ( < 0.05); in the hepatic right vein-accessory hepatic venous angiography group, it was 0.721 ( < 0.05); in the hepatic right vein-middle hepatic venous angiography group, it was 0.344 ( < 0.05); and in the hepatic right vein-nonangiography group, it was 0.293 ( < 0.05).

Conclusion: The presence and anatomical classification of hepatic venous collaterals are key factors influencing the relationship between WHVP with and PVP. Based on the different anatomical classifications of hepatic veins, WHVP can be used to estimate PVP, improving the accuracy of PVP prediction.