Transvenous extrahepatic portacaval shunt: Feasibility study in a swine model

Michael J Wallace, Kamran Ahrar, L. Clifton Stephens, Kenneth C. Wright

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

PURPOSE: To evaluate the feasibility of intravascular ultrasonography (US)-guided access to the extrahepatic segment of the main portal vein (PV) to create a transvenous extrahepatic portacaval shunt (TEPS) as an easier and more durable alternative to transjugular intrahepatic portosystemic shunt. MATERIALS AND METHODS: PV access from the inferior vena cava (IVC) to the main PV was performed in eight pigs by using intravascular US guidance. Either a prototype stent-graft (n = 6) of Wallgraft (n = 2) was used to create the shunt. Intravascular US demonstrated the main PV to be in direct contact with the IVC in all animals. A mean of 1.75 needle passes were needed to enter the PV. Immediate postprocedure computed tomography (CT) of the abdomen helped identify and quantify the presence of hemoperitoneum. Shunt venography was performed at 2 weeks, followed by necropsy. RESULTS: PV access and TEPS creation were successful in all animals. Contrast medium extravasation, due to inadequate coverage of the portacaval tract, was identified in four procedures and addressed by the placement of additional devices in three cases and prolonged balloon inflation in one. Abdominal CT demonstrated small amounts of hemoperitoneum in five animals and moderate to large amounts in three. Two animals did not live to the 2-week follow-up study. One animal was sacrificed on the day of the procedure owing to intraperitoneal hemorrhage; the second died of intussusception-related bowel necrosis 10 days after TEPS creation. Shunts were occluded or severely stenotic at venography and necropsy in the remaining six animals. CONCLUSION: TEPS is technically feasible after intravascular US-guided PV access.

Original languageEnglish (US)
Pages (from-to)119-125
Number of pages7
JournalRadiology
Volume228
Issue number1
DOIs
StatePublished - Jul 1 2003

Fingerprint

Surgical Portacaval Shunt
Feasibility Studies
Portal Vein
Interventional Ultrasonography
Swine
Hemoperitoneum
Phlebography
Inferior Vena Cava
Extravasation of Diagnostic and Therapeutic Materials
Tomography
Transjugular Intrahepatic Portasystemic Shunt
Intussusception
Economic Inflation
Abdomen
Needles
Stents
Necrosis
Hemorrhage
Transplants
Equipment and Supplies

Keywords

  • Animals
  • Interventional procedures, experimental studies
  • Shunts, portacaval
  • Stents and prostheses
  • Ultrasound (US), guidance

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Transvenous extrahepatic portacaval shunt : Feasibility study in a swine model. / Wallace, Michael J; Ahrar, Kamran; Stephens, L. Clifton; Wright, Kenneth C.

In: Radiology, Vol. 228, No. 1, 01.07.2003, p. 119-125.

Research output: Contribution to journalArticle

Wallace, Michael J ; Ahrar, Kamran ; Stephens, L. Clifton ; Wright, Kenneth C. / Transvenous extrahepatic portacaval shunt : Feasibility study in a swine model. In: Radiology. 2003 ; Vol. 228, No. 1. pp. 119-125.
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