title: Experimental percutaneous extrahepatic portacaval shunt creation by transjugular approach in Swine.
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.
authors.affiliation: Dotter Interventional Institute, Oregon Health & Science University, L342, 3181 SW Sam Jackson Park Road, Portland, OR 97201, USA. pavcnikd@ohsu.edu
authors.forename: Chang Kyu
authors.initials: CK
authors.lastname: Seong
authors.forename: Dusan
authors.initials: D
authors.lastname: Pavcnik
authors.forename: Barry T
authors.initials: BT
authors.lastname: Uchida
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Anai
authors.forename: Hans
authors.initials: H
authors.lastname: Timmermans
authors.forename: Mahtab
authors.initials: M
authors.lastname: Niyyati
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Corless
authors.forename: Luiz O
authors.initials: LO
authors.lastname: Correa
authors.forename: Frederick S
authors.initials: FS
authors.lastname: Keller
authors.forename: Josef
authors.initials: J
authors.lastname: Rösch
mesh_terms: D000818:Animals; D019917:Blood Vessel Prosthesis Implantation; D004195:Disease Models, Animal; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology; D006465:Hemoperitoneum / Q000000981:diagnostic imaging / Q000209:etiology; D007601:Jugular Veins / Q000601:surgery*; D008099:Liver / Q000098:blood supply* / Q000601:surgery*; D017537:Mesenteric Artery, Inferior / Q000000981:diagnostic imaging / Q000601:surgery; D011167:Portacaval Shunt, Surgical; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D011172:Portography; D011475:Prosthesis Failure; D015607:Stents; D013552:Swine; D014654:Vascular Patency; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000601:surgery*