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Percutaneous extrahepatic portacaval shunt with covered prostheses: feasibility study
Isabel Vivas1, José I Bilbao, Antonio Martínez-Cuesta
1Department of Radiology, Clínica Universitaria, Faculty of Medicine, University of Navarra, C/Pío XII 36, 31008 Pamplona, Spain. isvivasp@unav.es
Journal of Vascular and Interventional Radiology : JVIR
|December 5, 2003
Summary
Percutaneous extrahepatic portosystemic shunt (PEPS) creation is anatomically feasible in cirrhosis patients, with the lower main portal vein (MPV) being the optimal site. Animal studies show promise but require further refinement for efficacy.
Area of Science:
- Interventional Radiology
- Hepatology
- Vascular Surgery
Background:
- Cirrhosis often leads to portal hypertension, necessitating shunting procedures.
- Extrahepatic portosystemic shunts offer an alternative to transjugular intrahepatic portosystemic shunts (TIPS).
Purpose of the Study:
- To assess the anatomical feasibility of percutaneous extrahepatic portosystemic shunt (PEPS) creation between the main portal vein (MPV) and inferior vena cava (IVC) in cirrhosis patients.
- To evaluate the feasibility of the PEPS approach in an animal model.
Main Methods:
- CT scans of 34 cirrhosis patients analyzed for MPV-IVC distance and intervening structures.
- PEPS creation attempted in 10 beagle dogs using a novel polyurethane-covered prosthesis.
Main Results:
- The lower third of the MPV offered the shortest distance (1.18 cm) and predictable anatomy for PEPS creation in human studies.
- In dogs, 6/10 died from bleeding or prosthesis dislodgement; 4 survived for up to 90 days.
Conclusions:
- PEPS creation is anatomically possible in cirrhosis patients, with the lower MPV as the preferred site.
- Preliminary canine studies support PEPS feasibility, but technique refinement is crucial for improved efficacy.