The feasibility study of transjugular extrahepatic portacaval shunt_West China Medical Journal

Authors：

LI Jingui ¹ ,  LI Xiao ^2,3

1. West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Center of Interventional Diagnosis and Therapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Interventional Department, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, 100021, P. R. China;

Corresponding author：

LI Xiao, Email: simonlixiao@163.com

Keywords：

Portal hypertension; Extrahepatic portacaval shunt; Fluency covered stent

DOI：

10.7507/1002-0179.201704047

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the feasibility of X-ray guided access to the extrahepatic segment of the main portal vein (PV) to create a transjugular extrahepatic portacaval shunt (TEPS). Methods 5F pigtail catheter was inserted into the main PV as target catheter by percutaneous transhepatic path under ultrasound guidance. The RUPS-100 puncture system was inserted into the inferior vena cava (IVC) by transjugular path under ultrasound guidance. Fluency covered stent was deployed to create the extrahepatic portacaval shunt after puncturing the target catheter from the IVC under the X-ray guidance, then shunt venography was performed. Enhanced CT of the abdomen helped identify and quantify the patency of the shunt and the presence of hemoperitoneum. Results The extrahepatic portacaval shunts were created successfully by only 1 puncture in 6 pigs. No extravasation was observed in shunt venography. One pig died of anesthesia on the day of operation. The extrahepatic portacaval shunts were failed in 2 pigs 3 days after the operation (one was occluded and the other one was narrowed by 80%). The extrahepatic portacaval shunts were occluded 2 weeks after the operation in the remaining 3 pigs. The shunts were out of the liver and no hemoperitoneum was identified at necropsy in the 6 pigs. Conclusion TEPS is technically safe and feasible under the X-ray guidance.

Citation： LI Jingui, LI Xiao. The feasibility study of transjugular extrahepatic portacaval shunt. West China Medical Journal, 2017, 32(7): 980-983. doi: 10.7507/1002-0179.201704047 Copy

1.	Planas R, Montoliu S, Ballesté B, et al. Natural history of patients hospitalized for management of cirrhotic ascites. Clin Gastroenterol Hepatol, 2006, 4(11): 1385-1394.
2.	Orloff MJ, Hye RJ, Wheeler HO, et al. Randomized trials of endoscopic therapy and transjugular intrahepatic portosystemic shunt versus portacaval shunt for emergency and elective treatment of bleeding gastric varices in cirrhosis. Surgery, 2015, 157(6): 1028-1045.
3.	Boyer TD, Haskal ZJ, American Association for the Study of Liver Diseases. The role of transjugular intrahepatic portosystemic shunt (tips) in the management of portal hypertension: update 2009. Hepatology, 2010, 51(1): 306.
4.	European Association for the Study of the Liver. EASL clinical practice guidelines: vascular diseases of the liver. J Hepatol, 2016, 64(1): 179-202.
5.	European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol, 2010, 53(3): 397-417.
6.	García-Pagán JC, Caca K, Bureau C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med, 2010, 362(25): 2370-2379.
7.	祁兴顺, 韩国宏, 樊代明. 经颈内静脉肝内门体分流术临床应用新进展. 介入放射学杂志, 2011, 20(6): 499-504.
8.	Ward TJ, Techasith T, Louie JD, et al. Emergent salvage direct intrahepatic portocaval shunt procedure for acute variceal hemorrhage. J Vasc Interv Radiol, 2015, 26(6): 829-834.
9.	Wallace MJ, Ahrar K, Stephens LC, et al. Transvenous extrahepatic portacaval shunt: feasibility study in a swine model. Radiology, 2003, 228(1): 119-125.
10.	Kovalak M, Lake J, Mattek N, et al. Endoscopic screening for varices in cirrhotic patients: data from a national endoscopic database. Gastrointest Endosc, 2007, 65: 82-88.
11.	Carbonell N, Pauwels A, Serfaty L, et al. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology, 2004, 40(3): 652-659.
12.	Lenz K, Buder R, Kapun L, et al. Treatment and management of ascites and hepatorenal syndrome: an update. Therap Adv Gastroenterol, 2015, 8(2): 83-100.
13.	Holster IL, Tjwa Moelker A, et al. Covered transjugular intrahepatic portosystemic shunt versus endoscopic therapy+β-blocker for prevention of variceal rebleeding. Hepatology, 2016, 63(2): 581-589.
14.	Runyon BA, AASLD. Introduction to the revised American association for the study of liver diseases practice guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology, 2013, 57(4): 1651-1653.
15.	Petersen B. Intravascular ultrasound-guided direct intrahepatic portacaval shunt: description of technique and technical refinements. J Vasc Interv Radiol, 2003, 14(1): 21-32.
16.	Petersen BD, Clark TW. Direct intrahepatic portocaval shunt. Tech Vasc Interv Radiol, 2008, 11(4): 230-234.

1. Planas R, Montoliu S, Ballesté B, et al. Natural history of patients hospitalized for management of cirrhotic ascites. Clin Gastroenterol Hepatol, 2006, 4(11): 1385-1394.
2. Orloff MJ, Hye RJ, Wheeler HO, et al. Randomized trials of endoscopic therapy and transjugular intrahepatic portosystemic shunt versus portacaval shunt for emergency and elective treatment of bleeding gastric varices in cirrhosis. Surgery, 2015, 157(6): 1028-1045.
3. Boyer TD, Haskal ZJ, American Association for the Study of Liver Diseases. The role of transjugular intrahepatic portosystemic shunt (tips) in the management of portal hypertension: update 2009. Hepatology, 2010, 51(1): 306.
4. European Association for the Study of the Liver. EASL clinical practice guidelines: vascular diseases of the liver. J Hepatol, 2016, 64(1): 179-202.
5. European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol, 2010, 53(3): 397-417.
6. García-Pagán JC, Caca K, Bureau C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med, 2010, 362(25): 2370-2379.
7. 祁兴顺, 韩国宏, 樊代明. 经颈内静脉肝内门体分流术临床应用新进展. 介入放射学杂志, 2011, 20(6): 499-504.
8. Ward TJ, Techasith T, Louie JD, et al. Emergent salvage direct intrahepatic portocaval shunt procedure for acute variceal hemorrhage. J Vasc Interv Radiol, 2015, 26(6): 829-834.
9. Wallace MJ, Ahrar K, Stephens LC, et al. Transvenous extrahepatic portacaval shunt: feasibility study in a swine model. Radiology, 2003, 228(1): 119-125.
10. Kovalak M, Lake J, Mattek N, et al. Endoscopic screening for varices in cirrhotic patients: data from a national endoscopic database. Gastrointest Endosc, 2007, 65: 82-88.
11. Carbonell N, Pauwels A, Serfaty L, et al. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology, 2004, 40(3): 652-659.
12. Lenz K, Buder R, Kapun L, et al. Treatment and management of ascites and hepatorenal syndrome: an update. Therap Adv Gastroenterol, 2015, 8(2): 83-100.
13. Holster IL, Tjwa Moelker A, et al. Covered transjugular intrahepatic portosystemic shunt versus endoscopic therapy+β-blocker for prevention of variceal rebleeding. Hepatology, 2016, 63(2): 581-589.
14. Runyon BA, AASLD. Introduction to the revised American association for the study of liver diseases practice guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology, 2013, 57(4): 1651-1653.
15. Petersen B. Intravascular ultrasound-guided direct intrahepatic portacaval shunt: description of technique and technical refinements. J Vasc Interv Radiol, 2003, 14(1): 21-32.
16. Petersen BD, Clark TW. Direct intrahepatic portocaval shunt. Tech Vasc Interv Radiol, 2008, 11(4): 230-234.

West China Medical Journal

The feasibility study of transjugular extrahepatic portacaval shunt

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