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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).

View larger version (175K): [in a new window]   Figure 1. Intravascular US image obtained before shunt creation demonstrates the relationship between IVC and portal vein (PV). The intravascular US catheter (arrow) and curved 14-gauge cannula (arrowhead) are situated in the IVC lumen.

View larger version (161K): [in a new window]   Figure 2. Intravascular US image obtained during portal vein access shows tenting (white arrow) of the portal vein (PV) caused by rotation of the 14-gauge curved cannula, indicating site of needle entry. Note intravascular US catheter (black arrow) within the IVC.

View larger version (95K): [in a new window]   Figure 3a. Digital subtraction venogram obtained immediately after TEPS creation in two animals. (a) In animal 1, contrast medium injected through a sheath in the inferior vena cava (IVC) opacifies the shunt, prototype flanged stent-graft (arrowhead), IVC, and portal vein (PV). (b) In animal 8, contrast medium injected into the portal vein (PV) opacifies the Wallgraft (arrowhead) used to create the shunt, portal vein, and IVC. Note oblique orientation of the shunt in both a and b.

View larger version (95K): [in a new window]   Figure 3b. Digital subtraction venogram obtained immediately after TEPS creation in two animals. (a) In animal 1, contrast medium injected through a sheath in the inferior vena cava (IVC) opacifies the shunt, prototype flanged stent-graft (arrowhead), IVC, and portal vein (PV). (b) In animal 8, contrast medium injected into the portal vein (PV) opacifies the Wallgraft (arrowhead) used to create the shunt, portal vein, and IVC. Note oblique orientation of the shunt in both a and b.

View larger version (140K): [in a new window]   Figure 4. Photograph of TEPS at necropsy performed 2 weeks after the initial procedure in animal 8. The shunt (arrow) joins the IVC and portal vein (PV). The portacaval space above and below the level of the shunt shows extrahepatic location of entry into the portal vein.

View larger version (179K): [in a new window]   Figure 5. Necropsy photograph of the IVC portion of TEPS in animal 1. A prototype stent-graft was used. Note legs of the device (arrowheads) protruding into the lumen of the IVC and severe pseudointimal hyperplasia (arrows) covering the opening of the shunt.