Extrahepatic portacaval shuntviaa magnetic compression technique: A cadaveric feasibility study

Abstract

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. 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 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 ORIGINAL ARTICLE Basic StudyExtrahepatic portacaval shunt via a magnetic compression technique: A cadaveric feasibility study technical and subject to postoperative complications. Side-to-side portacaval shunt has a high incidence of hepatic encephalopathy [2,3] . H-graft portacaval shunt, as a limited portacaval shunt, can effectively reduce the incidence of hepatic encephalopathy [4] . However, it is also technically challenging and patients who undergo the procedure must be put on long-term use of anticoagulants.The magnetic compression technique (MCT) exploits the attraction between magnets to pull together an area of ischemic necrosis and its surrounding tissue to promote healing. The major advantages of the MCT are that it is simple, minimally invasive and reliable. Currently, MCT is applied in esophageal atresia [5,6] , biliary stenosis [7][8][9][10][11][12] , vascular anastomosis [13][14][15][16][17][18][19] and gastro-intestinal anastomosis [20][21][22][23][24][25][26][27] . Previously, we applied Roux-en-Y choledochojejunostomy incorporating MCT for obstructive jaundice in a canine model [28] . We also confirmed that magnetic rings could be used for rapid vascular reconstruction in a canine liver transplantation model [19] . We first reported the establishment of a portacaval shunt using MCT in dogs, the significant advantage of which is that no stent or any other foreign device was installed [29] . In the present study, we assessed some anatomical parameters that might affect the establishment of extrahepatic portacaval shunt using MCT in humans, and performed five preliminary cadaveric s...

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