Hepatic Vein Sampling

This procedure is done to help localize insulinomas (insulin secreting tumors of the pancreas) in patients that are experiencing episodes of unexplained severe hypoglycemia (low blood sugar) with no history of diabetes.  Patients will often be post-operative gastric bypass. This is done in preparation for partial pancreatectomy (removal of a portion of the pancreas).

What happens during the procedure?

Conscious sedation is provided prior to and throughout the procedure. You will lie flat on the x-ray table and will be connected to several types of monitoring equipment.  The technologist will prepare the skin over the neck and groin area by cleaning it with an antiseptic solution and place sterile drapes and towels over you to create a sterile work place.

Lidocaine local anesthetic is injected into the skin overlying the right internal jugular vein in the neck and the right femoral artery in the groin.  Contrast dye is injected to allow visualization of the arteries which supply the pancreas.  The contrast causes a brief mild warm feeling as it enters your bloodstream.  During the test the Interventional Radiologist may ask you to hold your breath for five to fifteen seconds.  In addition, you may be asked to lie perfectly still to prevent sudden movement from blurring the x-ray pictures.

One at a time, three arteries supplying different areas of the pancreas will be injected with calcium gluconate to stimulate the release of insulin.  Subsequently, blood samples will be collected from the hepatic vein to measure levels of insulin and help determine the location of the pancreatic insulinoma.

When the procedure is completed, the catheter is removed and pressure is applied over the area.

The artery and vein until there is no bleeding (approximately 15 minutes).The procedure takes about one to two hours.

What happens after the procedure?
Since conscious sedation medicine was administered and the femoral artery has been punctured, you will be required to stay to recover for four to six hours after the end of the procedure. While in recovery, you will be monitored closely for signs of bleeding from the vein in the neck and the artery in the groin and to ensure that the effects of the sedation have worn off.  You must have a responsible adult to drive/escort them home from the hospital.

Going home:
Since the artery is a high pressure system, patients should refrain from lifting more than ten pounds, refrain from strenuous activity or anything which causes abdominal distension for the following 48-72 hours.  Any straining such as vomiting, coughing, or forced bowel movements could dislodge the clot that forms to seal the artery and cause bleeding.  If you notice any signs of bleeding such as bulging under the skin the size of a golf ball, put direct pressure to the area and go to the nearest emergency room or call 911 for assistance.  Do not take a tub bath, go in a hot tub or submerge in water for five days.  Report any signs of infection (redness swelling, discharge and fever) to your doctor.  At home you can eat normally but you should drink extra fluids for one to two days following the procedure.  The results of your hepatic venous sampling will be sent to your primary care physician who will then contact you.

If you have any questions please feel free to contact the Interventional Radiology Office at 802-847-8359. If you need to reschedule your appointment please call the Interventional Radiology Department directly at (802) 847 3663.

This information is provided by the Fletcher Allen Department of Radiology, Division of Interventional Radiology and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact your health care provider.