Direct intrahepatic portacaval shunt: an experimental study

AIM:To determine the feasibility of creating directintrahepatic portacaval shunt(DIPS)in swine with punctureunder sonographic guidance.METHODS:DIPS was created in 10 domestic swine undersonographic guidance.Liver function,blood ammonia leveland portosystemic gradient(PSG)were compared beforeand after the procedure.Patency of shunt was followed byportography every 7 days after DIPS.RESULTS:DIPS was successfully established in all 10 swinewithout any complications.One day after procedure thealanine aminotransferase(ALT),aspartate aminotransferase(AST),and blood ammonia level(BAL)of swine rose from5.40±0.69,16.00±0.79 and 35.66±4.10 to 34.20±3.46,59.70±2.22 and 66.94±3.44 respectively.(P<0.05).The PSGdecreased from 0.59±0.20 kPa to 0.24±0.11 kPa after DIPS(P<0.05).The shunt of 10 swine was kept patent from 7-28days(median patency time was 14 days).CONCLUSION:This initial experience demonstrated thatcreating intrahepatic portacaval shunt from retrohepaticsegment of IVC to portal vein with puncture undersonographic guidance in swine is safe and feasible.Furtherstudies are necessary to perform DIPS in cirrhosis patients.