A flexible stent with small intestinal submucosa covering for direct intrahepatic portocaval shunt: Experimental pilot study in swine

Mahtab Niyyati, Bryan D. Petersen, Dusan Pavcnik, Barry T. Uchida, Hans A. Timmermans, Takao Hiraki, Reng Hong Wu, Elias Brountzos, Frederick S. Keller, Josef Rösch

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

The suitability of the flexible sandwich Zilver stent-graft (SZSG) with a biologically active tissue layer (small intestinal submucosa) for creation of the intravascular ultrasound (IVUS)-guided direct intrahepatic portocaval shunt (DIPS) was explored in six young swine in a search for a flexible system to replace the rigid polytetrafluoroethylene (PTFE) stent originally used by this group with limited success. The portal vein was punctured from the inferior vena cava through the caudate lobe of the liver using IVUS guidance. After balloon dilation of the puncture tract, DIPS was successfully created in all animals with use of an SZSG 9 mm in diameter and 6 cm or 8 cm long. Only one DIPS remained well patent at 14 days when the animal had to be killed because of encephalopathy. DIPS in the other five animals were found to be either severely stenosed (3 animals) or occluded (2 animals) at 4 weeks due to accelerated formation of neointimal hyperplasia (NIH) in the liver parenchymal portion of the shunt and superimposed thrombosis. The lack of high pressure in the portal system contributed to early endograft closure. The flexible stent and the covering fail badly. The reason for this could be due to either component. More work is required to find a reliable flexible system with long-term patency. Exploration of the IVUS-guided direct extrahepatic portocaval shunt is suggested.

Original languageEnglish (US)
Pages (from-to)215-220
Number of pages6
JournalCardiovascular and interventional radiology
Volume28
Issue number2
DOIs
StatePublished - Apr 1 2005

Keywords

  • Biomaterials
  • Endovascular stent-graft, Interventional treatment
  • Portal hypertension
  • Portocaval shunt
  • Small intestinal submucosa

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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