Hepatic Angiogram - Good News

Yesterday was another trip to Northwestern Memorial Hospital in Chicago and another liver procedure for me in the Interventional Radiology (IR) department. The primary purpose of yesterday's procedure was to try to find the cause of the high pressure that was seen in my liver and in the portal vein that feeds into the liver. The main procedure that was planned was a Hepatic Angiogram which is the insertion of dye into the liver (via a catheter which is inserted into the hepatic artery) and the subsequent taking of x-rays of the liver to get a good mapping of the blood vessels in the liver. However, additional testing was also planned to measure the pressure of the blood that leaves the liver and comes into the heart to see if the problem was not in the liver but actually a heart issue.

My wife and I got to the hospital around 9:40 for my 10:00 appointment with the actual procedure planned for 11:00. As I was filling out my paperwork at around 9:50 the nurse came out and got us so that I could begin to get prepped for the procedures. We went back and I finished the paperwork, got changed and got onto my gurney. The nurse checked my vitals and started the IV and then we waited. This was a little after 10 and we assumed that the procedure would start close to 11 as my previous ones had all been either on time or a little early. Luckily my wife and I both had some reading material. Around 10:50 the nurse came back with the news that my procedure room (the "best" one in the IR department according to my doctor) was still in use and my procedure would likely be delayed until 12:30. This was fine but a little different compared to the previous visits. Between 11 and 12:30 we were able to talk to my primary IR doctor (Dr. Lewandowski, who had done my previous PVE procedure) and one of the fellows (Dr. Scanlon) who would be assisting in today's procedure. At 12:30 I was wheeled back to the procedure room.

The procedure room for this procedure was the same one I had been in for the PVE. It contained a large imaging machine above me as well as a large bank of video displays for the doctor to see the images. Once I was on the table I was prepped for the procedure. As the doctors were planning to look at both the veins above my liver and the artery coming into the bottom of my liver it was necessary to prepare 2 locations for entry. The first part of the procedure would be coming into a small incision in my neck which they would feed the catheter into the veins leaving my liver (hepatic vein). The second part of the procedure (the actual Angiogram) would be coming into a small incision in my groin which they would feed the catheter into the hepatic artery coming into my liver. So both entry points (right side of my neck and right side of my groin) were shaved and heavily painted with antiseptic.

Soon after this I was sedated and I slept through the first hour of the procedure (the work through my neck to check the pressure in the veins leaving my liver). Unlike my previous procedures, however, I was awake for most of the remainder of this procedure. At some point I started hearing the doctor talking to me and telling me that I needed to hold my breath for a short period of time. I assume that this was part of the angiogram so that they could get clear x-ray images after the dye had been inserted. I am not clear on the duration of this part of the procedure but overall everything took around 2 hours (from 12:45 to 2:45). I was feeling some pain in the groin area when I was waking up during the procedure and I mentioned this to a nurse. They must have given me more of the pain medication as this did not seem to continue to be a problem.

As an aside, one thing that I have learned through the 3 procedures that I have had is that there are 3 elements to the medication that I am given. The first part is for the pain relief, the second part is to relax me (this usually puts me to sleep) and a third part is to make me forget the experience. I guess I could have guessed the first 2 but I didn't realize until now about this third part which must help people after the procedure who wouldn't want to remember any of the pain if they were not asleep through the whole thing.

Around 2:45 I was wheeled back into recovery and I was there until 4:45 when we were able to leave the hospital. During this time we spoke again with Dr. Scanlon and Dr. Lewandowski and we learned that everything had gone very well. The first good news was that the pressure in the veins above the liver were all normal so this means that there is no issue with my heart. The pressure problem had to be in the liver. The second good news was that they did find an issue within my tumor where a vein and an artery were cross-wired. This fistula appears to be the cause of the high pressure in my portal vein as the pressure in the arteries is much higher than in the veins and the fistula was causing this pressure to enter my venous system. The reason that this news was "good" is that it removed the mystery of why I had this high pressure and it concluded that I have a single liver issue (my tumor) and not multiple issues (as was possible when they found the high pressure during the PVE procedure).

Dr Lewandowski discussed the findings with my liver surgeon (Dr. Baker) and liver specialist (Dr. Kulik) and they decided that it was safe to leave things alone and to go back to the initial plan of having surgery to remove the tumor. It was possible that if they had found some other malformation in my liver yesterday that they would have tried to repair it (embolize/blocking it up with coils) but as the issue was in the tumor which will be removed this was not necessary.

The left side of my liver should be growing at this time (it has now been 2 weeks since my PVE) and I will have a CT Scan or MRI within the next couple of weeks to confirm that it is large enough to proceed with the surgery. The surgery will be scheduled as soon as this is done.

Thanks again to all of the nurses, technicians and doctors at Northwestern. I have now been in the Interventional Radiology department 3 times in the last 2 weeks and the people working there have all been wonderful (though they are curious why I keep coming back). :)