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. TIPS creation was performed under fluoroscopy alone (FL=9), transparenchymal ultrasound (US=3) or IVUS guidance (IVUS=10). Technical success was defined as patent shunt post creation. Technical difficulty was graded by procedural time in minutes as low (<20), moderate (20-30), and high (>30). The number of punctures, fluoroscopic time and radiation dose were compared by technique. Results: Twenty-one TIPS were successfully created including 2 parallel TIPS. One technical failure occurred in FL group. The mean fluoroscopy time and radiation dose were 20 minutes (range 9 to 65) and 102 mGy (range 15-430). Technical difficulty was low in 13 (5 FL, 2 US, 6 IVUS), moderate in 5 (5 IVUS) and high in 3 (2 FL, 1 US). IVUS guidance decreased number of punctures fluoroscopic time and radiation dose. Conclusions: Explanted livers can be used to create an ex-vivo flow model for TIPS procedures training. The model is reproducible with varying degrees of technical difficulty and amendable to various techniques.
TIPS, Portal Hypertension, Cirrhosis