Creation of an Ex-vivo Transjugular Intrahepatic Portosystemic Shunt (TIPS) Training Model Using a Perfused Non-cirrhotic Porcine Liver

doi:10.33696/gastroenterology.2.032

Abstract

Purpose: To validate the feasibility of an ex-vivo flow model with explanted porcine livers for transjugular intrahepatic portosystemic shunt (TIPS) creation using different techniques. Material and Methods: Twenty porcine livers used for other non-related research were explanted after the animals were sacrificed. The inferior vena cava segments and portal vein were connected to vascular grafts. The portal vein graft was connected to a continuous 0.9% sodium chloride solution inflow by fountain pump

Highlights

Liver cirrhosis is growing problem worldwide with serious adverse clinical manifestations secondary to portal hypertension, including ascites, hydrothorax, bleeding from gastric and esophageal varices among others [1]
Twentyone Transjugular intrahepatic portosystemic shunt (TIPS) were successfully created including 2 parallel TIPS performed in the Intravascular US (IVUS) group
There was one technical failure in the fluoroscopy group, despite multiple punctures, only a very peripheral branch of the left portal vein was accessed with inability to advance the wire into the main portal vein, US guidance was not available for that experiment and the procedure was abandoned after 32 minutes of fluoroscopy

Summary

Introduction

Liver cirrhosis is growing problem worldwide with serious adverse clinical manifestations secondary to portal hypertension, including ascites, hydrothorax, bleeding from gastric and esophageal varices among others [1]. The use of live animals for training is limited by ethical issues and the high cost, the need for animal licenses, a dedicated animal facility and trained personnel including an anesthetist, and an operating room [5]. The high cost of these models and the lack of a realistic feel due to the issues with friction with the plastics, especially when trying to puncture the portal vein and advancing the stents and balloons through the tract, severely limits the utility of these models for TIPS training [5]. Having realistic models to train in the multiple steps of the procedure is very relevant for future interventional radiologist in order to become familiar with this technique, including needle bending, anterior vs posterior punctures, and use of adjunct techniques including

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Conclusion