Experimental percutaneous extrahepatic portacaval shunt creation by transjugular approach in Swine

The purpose of the study was to evaluate the feasibility of the creation of a percutaneous extrahepatic portacaval shunt (PEPS) in swine by a transjugular approach and to find a suitable stent-graft to use in PEPS. In 12 swine, the extrahepatic portal vein (PV) was entered from the inferior vena cav...

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Bibliographic Details
Published in:Cardiovascular and interventional radiology 2005-06, Vol.28 (5), p.616-623
Main Authors: Seong, Chang Kyu, Pavcnik, Dusan, Uchida, Barry T, Anai, Hiroshi, Timmermans, Hans, Niyyati, Mahtab, Corless, Christopher L, Correa, Luiz O, Keller, Frederick S, Rösch, Josef
Format: Article
Language:English
Subjects:
Animals
Blood clots
Blood Vessel Prosthesis Implantation
BYPASSES
Clinical trials
Disease Models, Animal
Female
Graft Occlusion, Vascular - diagnostic imaging
Graft Occlusion, Vascular - etiology
GRAFTS
Hemoperitoneum - diagnostic imaging
Hemoperitoneum - etiology
HEMORRHAGE
Jugular Veins - surgery
LIVER
Liver - blood supply
Liver - surgery
Mesenteric Artery, Inferior - diagnostic imaging
Mesenteric Artery, Inferior - surgery
PHOSPHOENOLPYRUVATE
Portacaval Shunt, Surgical
Portal Vein - diagnostic imaging
Portal Vein - surgery
Portography
Prosthesis Failure
RADIOLOGY AND NUCLEAR MEDICINE
Stents
SWINE
Vascular Patency
VEINS
Vena Cava, Inferior - diagnostic imaging
Vena Cava, Inferior - surgery
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Summary:The purpose of the study was to evaluate the feasibility of the creation of a percutaneous extrahepatic portacaval shunt (PEPS) in swine by a transjugular approach and to find a suitable stent-graft to use in PEPS. In 12 swine, the extrahepatic portal vein (PV) was entered from the inferior vena cava (IVC) by a needle system introduced from the transjugular approach. A catheter introduced through the transhepatic approach served as a target. Five types of stent-graft consisting of homemade Z stents and a polytetrafluoethylene cover were explored for PEPS creation. Eight animals had follow-up venograms up to 6 weeks or until the shunt became severely stenotic. Gross and histologic examinations were performed after the final follow-up venography. The PV punctures and stent-graft placement were difficult, but the PEPS was established in all animals. In four animals, the stent-graft failed to adequately cover the tract, causing severe hemorrhage. Only two shunts remained patent up to 6 weeks. The other shunts exhibited severe stenosis or occlusion. At gross examination, all shunts traversed the liver parenchyma of the caudate lobe surrounding the IVC. The extravascular PEPS portion was 4 mm to 2 cm long. All shunts entered the PV close to the splenomesenteric junction and exhibited neointimal formation. Shunt stenoses were caused by neointimal hyperplasia and occlusions by a superimposed thrombus. PEPS can be created by the transjugular approach in swine, but only the PV shunt entrance is extrahepatic. None of the tested rigid stent-grafts were suitable for PEPS creation. A short flexible stent-graft with flanged ends is suggested for further exploration.
ISSN:0174-1551
1432-086X
DOI:10.1007/s00270-004-0305-0