Clinical applications and complications of umbilical vein cannulation

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Abstract
Cannulation of the obliterated umbilical vein provides direct access to the portal venous circulation; by this means the portal venous pressure may be measured and venography performed to demonstrate the anatomy of the intra- and extrahepatic portal venous system and the presence of space-occupying lesions within the liver. Following dilatation the umbilical vein may also be used for temporary or permanent decompression of the portal system in patients with portal hypertension and bleeding oesophageal varices. The technique of cannulation of the umbilical vein is described. The results of attempted umbilical vein cannulation in 26 patients are reported; in 16 for the investigation or treatment of portal hypertension and in 10 for the diagnosis of suspected space-occupying lesions in the liver. Cannulation was successful in 12 patients: the reasons for failure and the complications of the technique are described. One patient with bleeding oesophageal varices was treated by a shunt between the umbilical vein and the upturned saphenous vein; the shunt functioned initially but later thrombosed, possibly owing to insufficient dilatation of the umbilical vein. The value of and indications for umbilical vein cannulation are discussed. The procedure may be technically difficult and is not free of complications, but can give valuable information in selected patients with portal hypertension and in patients with suspected, intrahepatic, space-occupying lesions. The high failure rate in this series may be related to initial lack of experience with the technique.

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