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Transvenous Extrahepatic Portacaval Shunt: Feasibility Study in a Swine Model¹

¹ From the John S. Dunn Center for Radiological Sciences, Section of Vascular and Interventional Radiology, Department of Diagnostic Radiology (M.J.W., K.A., K.C.W.) and the Department of Veterinary Medicine and Surgery (L.C.S.), University of Texas M.D. Anderson Cancer Center, Unit 325, 1515 Holcombe Blvd, Houston, TX 77030-4009. Received July 26, 2002; revision requested September 24; revision received October 14; accepted December 10. 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. Address correspondence to M.J.W. (e-mail: mwallace@mdanderson.org).

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) or 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.

© RSNA, 2003

Index terms: Animals • Interventional procedures, experimental studies, 957.1268 • Shunts, portacaval, 957.1268, 957.711 • Stents and prostheses • Ultrasound (US), guidance, 957.12986