Basic Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2015; 21(26): 8073-8080
Published online Jul 14, 2015. doi: 10.3748/wjg.v21.i26.8073
Extrahepatic portacaval shunt via a magnetic compression technique: A cadaveric feasibility study
Xiao-Peng Yan, Wen-Yan Liu, Jia Ma, Jian-Peng Li, Yi Lv
Xiao-Peng Yan, Wen-Yan Liu, Jian-Peng Li, Yi Lv, Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Xiao-Peng Yan, Wen-Yan Liu, Jia Ma, Jian-Peng Li, Yi Lv, XJTU Research Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Jia Ma, Department of Surgical Oncology, Third Affiliated Hospital, Xi’an Jiaotong University (Shaanxi Provincial People’s Hospital), Xi’an 710061, Shaanxi Province, China
Author contributions: Yan XP and Liu WY contributed equally to this work; Yan XP and Lv Y designed the study; Yan XP, Lv Y and Ma J performed the research and acquired the data; Yan XP and Li JP analyzed the data; Yan XP, Liu WY and Li JP drafted the manuscript; Yan XP, Liu WY, Ma J and Li JP contributed significantly to the revision of the manuscript.
Supported by Key Project of Clinical Discipline of Ministry of Health Subordinates of China, No. 2010105.
Institutional review board statement: The entire study was carried out in strict accordance with protocols approved by the Xi’an Jiaotong University Biomedical Ethics Committee (Ethics Permit Number: 2014-0303).
Institutional animal care and use committee statement: This study does not involve any animal experiments.
Conflict-of-interest statement: The authors declare no conflict of interests.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at luyi169@126.com. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yi Lv, MD, PhD, Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi’an Jiaotong University, 76 Yanta West Road, Xi’an 710061, Shaanxi Province, China. luyi169@126.com
Telephone: +86-29-82657541 Fax: +86-29-82657541
Received: December 19, 2014
Peer-review started: December 21, 2014
First decision: January 22, 2015
Revised: February 11, 2015
Accepted: March 18, 2015
Article in press: March 19, 2015
Published online: July 14, 2015
Processing time: 206 Days and 19.2 Hours
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.

Keywords: Portal vein; Inferior vena cava; Portacaval shunt; Magnetic compression technique; Anatomy; Cadaver

Core tip: The portacaval shunt using magnetic compression technique (MCT) was first established by our group in a canine model. Here, we assessed its feasibility in humans by analyzing computed tomography images and the anatomical parameters of cadavers. The average diameters of the portal vein (PV), the inferior vena cava (IVC) and the distances between the PV and the IVC were all within the parameters that allowed the setup of portacaval shunt using MCT. Finally, first stage simulation of the portacaval shunt was successfully set up in five cadavers. Our results indicated that the portacaval shunt is highly feasible in humans.