TY - JOUR
T1 - Transvenous extrahepatic portacaval shunt with use of a modified prototype stent-graft
T2 - Experimental study in animals
AU - Wallace, Michael J.
AU - Ahrar, Kamran
AU - Tinkey, Peggy
AU - Wright, Kenneth C.
N1 - Funding Information:
Supported in part by a grant from the John S. Dunn Research Foundation and by grant NIH-NCI CA-16672 from the National Cancer Institute. None of the authors have identified a conflict of interest.
PY - 2005/2
Y1 - 2005/2
N2 - PURPOSE: To evaluate the safety and short-term patency of an experimental transvenous extrahepatic portacaval shunt (TEPS) in an animal model. MATERIALS AND METHODS: With use of intravascular ultrasound (IVUS) guidance, the main portal vein (PV) was accessed from the inferior vena cava in six pigs and a TEPS was created with use of a prototype flanged stent-graft. Partial PV embolization was then performed to increase the post-TEPS PV pressure. Baseline and postprocedural hemoglobin and hematocrit measurements were obtained and liver function studies were conducted. Immediate postprocedural computed tomography (CT) of the abdomen was used to identify procedural complications. Follow-up venography was performed at 2, 4, and 12 weeks to assess short-term patency. Necropsy was performed at 3 months. RESULTS: IVUS-guided PV access was accomplished with a mean of two punctures per animal (range, 1-4). TEPS creation was successful in five of six animals. One animal was killed immediately after unsuccessful shunt creation after stent-graft misdeployment and hemorrhage. A second animal required the insertion of a conventional stent coaxially because portions of the leading arms were inadvertently deployed in the portacaval space and the initial flow through the shunt was venographically suboptimal. CT images obtained after successful TEPS creation (n = 5) revealed no evidence of hemoperitoneum, and there was no decrease in hemoglobin or hematocrit levels from baseline values. All five TEPSs were widely patent at 2-week and 4-week venography with only mild pseudointimal hyperplasia (<50% diameter stenosis) identified in one shunt. Twelve-week venography and necropsy demonstrated no evidence of shunt stenosis in one animal, less than 50% diameter stenosis in one animal, 50%-75% diameter stenosis in two animals, and shunt occlusion in one animal. CONCLUSION: Early results with TEPS with use of a modified prototype flanged stent-graft are promising as a potentially safe alternative means of portal decompression. Additional refinements of the stent-graft delivery process are needed to improve the accuracy of deployment.
AB - PURPOSE: To evaluate the safety and short-term patency of an experimental transvenous extrahepatic portacaval shunt (TEPS) in an animal model. MATERIALS AND METHODS: With use of intravascular ultrasound (IVUS) guidance, the main portal vein (PV) was accessed from the inferior vena cava in six pigs and a TEPS was created with use of a prototype flanged stent-graft. Partial PV embolization was then performed to increase the post-TEPS PV pressure. Baseline and postprocedural hemoglobin and hematocrit measurements were obtained and liver function studies were conducted. Immediate postprocedural computed tomography (CT) of the abdomen was used to identify procedural complications. Follow-up venography was performed at 2, 4, and 12 weeks to assess short-term patency. Necropsy was performed at 3 months. RESULTS: IVUS-guided PV access was accomplished with a mean of two punctures per animal (range, 1-4). TEPS creation was successful in five of six animals. One animal was killed immediately after unsuccessful shunt creation after stent-graft misdeployment and hemorrhage. A second animal required the insertion of a conventional stent coaxially because portions of the leading arms were inadvertently deployed in the portacaval space and the initial flow through the shunt was venographically suboptimal. CT images obtained after successful TEPS creation (n = 5) revealed no evidence of hemoperitoneum, and there was no decrease in hemoglobin or hematocrit levels from baseline values. All five TEPSs were widely patent at 2-week and 4-week venography with only mild pseudointimal hyperplasia (<50% diameter stenosis) identified in one shunt. Twelve-week venography and necropsy demonstrated no evidence of shunt stenosis in one animal, less than 50% diameter stenosis in one animal, 50%-75% diameter stenosis in two animals, and shunt occlusion in one animal. CONCLUSION: Early results with TEPS with use of a modified prototype flanged stent-graft are promising as a potentially safe alternative means of portal decompression. Additional refinements of the stent-graft delivery process are needed to improve the accuracy of deployment.
UR - http://www.scopus.com/inward/record.url?scp=14644402366&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=14644402366&partnerID=8YFLogxK
U2 - 10.1097/01.RVI.000045225.31334.E8
DO - 10.1097/01.RVI.000045225.31334.E8
M3 - Article
C2 - 15713928
AN - SCOPUS:14644402366
SN - 1051-0443
VL - 16
SP - 261
EP - 267
JO - Journal of Vascular and Interventional Radiology
JF - Journal of Vascular and Interventional Radiology
IS - 2 I
ER -