Extrahepatic portacaval shunt via a magnetic compression technique: A cadaveric feasibility study.

ABSTRACT

AIM: To explore the anatomical feasibility of portacaval shunt using a magnetic compression technique (MCT) in cadavers. METHODS: Computed tomography (CT) images of 30 portal hypertensive patients were obtained. The diameters of the portal vein (PV), the inferior vena cava (IVC), and distance between the two structures were measured. Similar measurements were performed on 20 adult corpses. The feasibility of portacaval shunt based on those measurements was analyzed. First stage of the extrahepatic portacaval shunt using MCT was performed on five cadavers. Specifically, the PV and IVC were exposed through an abdominal incision of the cadavers. The parent magnet was introduced from the femoral vein and was delivered into the IVC by an anchor wire and a 5F Cook catheter. The daughter magnet was introduced into the PV through the splenic vein using an interventional guide wire. When the daughter magnet met the parent magnet, they automatically clipped together and the first stage of the portacaval shunt was set up. RESULTS: The average diameters of the PV and the IVC measured from the 30 CT image were 14.39 ± 2.36 mm and 18.59 ± 4.97 mm, respectively, and the maximum and minimum distances between the PV and the IVC were 9.79 ± 4.56 mm and 9.50 ± 4.79 mm, respectively. From 20 cadavers, the average diameters of the PV and the IVC were 14.48 ± 1.47 mm and 24.71 ± 2.64 mm, and the maximum and minimum distances between the PV and the IVC were 10.14 ± 1.70 mm and 8.93 ± 1.17 mm, respectively. The distances between the PV and the IVC from both the CT images and the cadavers were within the effective length of portacaval anastomosis using MCT (30.30 ± 4.19 mm). The PV and IVC are in close proximity to each other with no intervening tissues or structures in between. Simulated surgeries of the first stage using MCT on five cadavers was successfully performed. CONCLUSION: Anatomically, extrahepatic portacaval shunt employing MCT is highly feasible in humans.