Evaluation of MR/Fluoroscopy–guided Portosystemic Shunt Creation in a Swine Model
Section snippets
Animal Model
The institutional animal care and use committee approved the animal studies. We performed experiments on 10 healthy swine (weight, 40–45 kg). Sedation was achieved with xylazine and ketamine. After endotracheal intubation, inhaled isoflurane (2%) was provided during mechanical ventilation with oxygen (98%). Percutaneous access into the right femoral vein was achieved under ultrasound (US) guidance, followed by placement of a 12-F sheath into the femoral vein. All animals were transferred to the
Stage 1: MR-guided Access to Portal-mesenteric Venous System
Successful MR-guided IVC/SMV/PV punctures were performed in all 13 procedures (100%). All procedures were performed with real-time MR imaging sequences with use of freebreathing techniques and without electrocardiographic gating. Punctures were made with no change in cardiac rhythm or rate and with no sequelae. As a result of the mobility of the SMV and PV, real-time imaging was necessary in all punctures to reorient the needle toward the target vessel. During real-time gradient-recalled echo
DISCUSSION
The creation of a percutaneous extrahepatic portosystemic shunt is contingent on two critical steps: (i) safe and dependable extrahepatic transcaval punctures into the portal circulation and (ii) a reliable conduit that will enable shunting into the systemic circulation. We demonstrated that with the use of multiplanar realtime MR imaging and conventional fluoroscopy, a percutaneous extrahepatic portosystemic shunt and an anastomosis can be constructed in a staged fashion. Under complete MR
CONCLUSIONS
Transcaval punctures to the portalmesenteric venous system are feasible with MR imaging guidance. Using a combination of MR imaging and conventional fluoroscopy for guidance, we were able to successfully create a percutaneous shunt and a vascular anastomosis between the portal mesenteric venous system and the IVC.
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This study was supported in part by National Institutes of Health grant 1 K08 EB004348-01, R01 HL61672. None of the authors have identified a conflict of interest.