2001 Fiscal Year Final Research Report Summary
Percutaneous retroperitoneal splenorenal shunt : an experimental study in swine
| Project/Area Number |
11670907
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
Radiation science
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| Research Institution | Osaka City University |
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Principal Investigator |
KAMINOU Toshio Osaka City University, Faculty of Medicine, Assistant Professor (20254401)
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| Co-Investigator(Kenkyū-buntansha) |
YAMADA Ryusaku Osaka City University, Faculty of Medicine, Professor (90047085)
NAKAMURA Kenji Osaka City University, Faculty of Medicine, Associate Professor (00145781)
MATSUOKA Toshiyuki Osaka City University, Faculty of Medicine, Lecturer (40295697)
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| Project Period (FY) |
1999 – 2001
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| Keywords | portal hypertension / spreno-renal shunt / interventional radiology / stent |
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| Research Abstract |
TIPS (Transjugular intrahepatic portosystemic shunt) is well known as an effective method for varices, but it has several complications. Especially hepatic encephalopathy is one of serious complications. We developed percutaneous retroperitoneal splenorenal shunt (PRESS) as a new procedure creating porto-systemic shunt without hepatic encephalopathy, and performed an experimental study in swine. First we made a special puncture set. We created a spleno-renal shunt through the retroperitoneal cavity by the transfemoral approach using a covered metallic stent. In the acute study we successfully created the shunt without any complications. Pressure gradient between the splenic vein and the IVC decreased immediately after the shunt creation. In the chronic study the shunt was obstructed or severely narrowed in most of the animals for 1 to 4 weeks. Gross inspection revealed that all stent-grafts were located in the retroperitoneal cavity and there was no intraperitoneal hemorrhage. PRESS was done with relative ease, and no major complication was observed in this study. All experimental procedures were guided only by fluoroscopy, but in a clinical setting ultrasonographic guidance could be used to avoid the penetration of the pancreatic parenchyma. In the case with liver cirrhosis the puncture of the splenic vein might be easier, because the splenic vein is wide and relatively close to the left renal vein.
We have shown that PRESS is technically feasible and is a potential new treatment for portal hypertension. Further experimental studies are necessary to evaluate if PRESS is effective in long term relief of portal hypertension and if it can be an alternative or replacement of TIPS.
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