Abstract
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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
M Rössle D Grandt (2004) ArticleTitleTIPS: an update Best Pract Res Clin Gastroenterol 18 IssueID1 99–123 Occurrence Handle10.1016/j.bpg.2003.08.004 Occurrence Handle15123087
JC Collins MJ Ong EB Rypins et al. (1998) ArticleTitlePartial portacaval shunt for variceal hemorrhage: longitudinal analysis of effectiveness Arch Surg 133 IssueID6 590–593 Occurrence Handle1:STN:280:DyaK1c3pvFGlug%3D%3D Occurrence Handle10.1001/archsurg.133.6.590 Occurrence Handle9637455
AS Rosemurgy FM Serafini BR Zweibel et al. (2000) ArticleTitleTransjugular intrahepatic portosystemic shunt vs. small-diameter prosthetic H-graft portacaval shunt: extended follow-up of an expanded randomized prospective trial J Gastrointest Surg 4 589–597 Occurrence Handle1:STN:280:DC%2BD3Mzlt1yqug%3D%3D Occurrence Handle10.1016/S1091-255X(00)80107-9 Occurrence Handle11307093
M Wolff A Hirner (2003) ArticleTitleCurrent state of portosystemic shunt surgery Langenbecks Arch Surg 388 IssueID3 141–149 Occurrence Handle10.1007/s00423-003-0367-5 Occurrence Handle12942328
T Kaminou J Rösch R Yamada et al. (1998) ArticleTitlePercutaneous retroperitoneal splenorenal shunt: an experimental study in swine Radiology 206 799–802 Occurrence Handle1:STN:280:DyaK1c7lsFKjug%3D%3D Occurrence Handle10.1148/radiology.206.3.9494504 Occurrence Handle9494504
MJ Wallace K Ahrar LC Stephens et al. (2003) ArticleTitleTransvenous extrahepatic portacaval shunt: feasibility study in a swine model Radiology 228 119–125 Occurrence Handle10.1148/radiol.2281020917 Occurrence Handle12714681
Vivas I, Bilbao JI, Martinez-Cuesta A, et al. (2000) Percutaneous extrahepatic portacaval shunt (PEPS) with covered prostheses: an alternative to TIPS. Radiology 217(suppl):508
Vivas I, Bilbao JI, Martinez-Cuesta A, et al. (2003) Percutaneous extrahepatic portacaval shunt with covered prostheses: feasibility study. J Vasc Intervent Radiol 14:1543–1552
Wallace MJ, Ahrar K, Wright KC. (2004) Transvenous extrahepatic portacaval shunt: experimental study in the animals. J Vasc Intervent Radiol 15(suppl):S192
M Niyyati B Petersen D Pavcnik et al. (2005) ArticleTitleResults of the flexible stent and small intestinal submucosa covering for the direct intrahepatic portocaval shunt: experimental pilot study in swine Cardiovasc Interv Radiol 28 IssueID2 215–220 Occurrence Handle10.1007/s00270-003-0261-0
Peterson B, Uchida BT, Timmermans H, et al. (2001) Intravascular US-guided direct intrahepatic portocaval shunt with a PTFE-covered stent-graft: feasibility study in swine and initial clinical results. J Vasc Intervent Radiol 12:475–486
Sarfeh IJ, Rypins EB (1988) Partial shunting for portal hypertension: surgical technique. Contemp Surg 32:11–16
EB Rypins IJ Sarfeh (1990) ArticleTitleSmall-diameter portacaval H-graft for variceal hemorrhage Surg Clin North Am 70 IssueID2 395–404 Occurrence Handle1:STN:280:DyaK3c3gvVGquw%3D%3D Occurrence Handle2321115
McLoughlin RF, Rankin (1996) Portocaval space anatomy: potential implication for percutaneous portocaval shunts. J Vasc Intervent Radiol 7:761–767
Nyman UR, Semba CP, Chang H, et al. (1996) Percutaneous creation of a mesocaval shunt. J Vasc Intervent Radiol 7:769–773
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Seong, C.K., Pavcnik, D., Uchida, B.T. et al. Experimental Percutaneous Extrahepatic Portacaval Shunt Creation by Transjugular Approach in Swine. Cardiovasc Intervent Radiol 28, 616–623 (2005). https://doi.org/10.1007/s00270-004-0305-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-004-0305-0