Discussion Of The Channel About Stent Placement Of Direct Intrahepatic Portacaval Shunt In Rabbit Guided By Ultrasound

Cirrhotic of the liver caused by Portal hypertension is the portal vein and its branches vascular complications caused by pressure increase. Including complications such as bleeding of esophagus and gastric fundus, hypersplenism, intractable ascites and hydrothorax, hepatorenal syndrome, Budd-Chiari syndrome caused by occlusion of hepatic vein. With the development of medical technology, percutaneous internal jugular vein to establish intrahepatic portasystemic stent shunt(TIPS) guided by X-ray has become one of the main means of interventional minimally invasive treatment of portal hypertension and its complications.In the clinical, we may have problems, such as internal jugular vein stenosis or occlusion, superior vena cava stenosis or occlusion, hepatic vein occlusion, intra atrial obstructive diseases, massive ascites, one pulmonary atelectasis caused the displacement of mediastinum. The traditional TIPS operation may be difficult to implement. With the development of interventional technology under the guidance of ultrasound, percutaneous transhepatic portal vein and retrohepatic segment of inferior vena cava(RHSIVC) to establish direct intrahepatic portacaval shunt(DIPS) guided by ultrasound combined X-ray has become hot. In order to avoid radioactive ray, under the guidance of ultrasound separated from X-ray, we created the stent about direct intrahepatic portacaval shunt(DIPS) which vias right portal vein(RPV) to retrohepatic segment of inferior vena cava(RHSIVC) in ten rabbits. This study aimed to investigate its feasibility and safety.We used ultrasound to measure the birfurcation of portal vein(BPV), the left portal vein(LPV), the right portal vein(RPV) and RHSIVC before the operation. The average diameter of vessel was 0.352、0.194、0.228、0.377 cm. Through the observation of the position relationships between BPV, LPV, RPV and RHSIVC, we created the stent between RPV and RHSIVC. The average of the stent is 1.017 cm, the average of angle between RPV and RHSIVC is 22.38°, Under the guidance of ultrasound, ten rabbits were percutaneous punctured RPV under the xiphoid, adjusted the angle of the needle, punctured into RHIVC and sent the guide wire, then along the guide wire into the stent. Observed the stent filled with blood and the blood flow velocity in the stent after the operation. The rabbits were dissected after the operation, observed the postion of the stent, whether the guide wire was into the proximal RHSIVC,and whether the complication happened such as subcapsular hemorrhage, intraperitoneal bleeding or organ injury.Nine rabbits were succeed to creating the stent between the RPV and the RHSIVC, the average of stent flow is 8.17 cm/s, one rabbit’s abdomen has a great quantity gas, RHSIVC was not clear to see. The rabbit died due to inferior vena cava hemorrhage when we punctured RHSIVC. The puncture average number of RPV and RHSIVC was 1.30、1.50 times, the average time of the operation was 11.40 minate. Postoperative anatomy of 9 rabbits confirmed stents were existed between the RPV and the RHSIVC, the guide wires were into the proximal RHSIVC, without subcapsular hemorrhage, intraperitoneal bleeding or organ injury.Our initial experiment demonstrated that percutaneous punctured RPV into RHSIVC to establish the stent was safety and feasibility. However, it would takes more experiments to see if this technology could be used in clinic.