Loading

logo

Archives of Gastroenterology Research

ISSN: 2692-5427

Research Article Open Access
Volume 2 | Issue 3 | DOI: https://doi.org/10.33696/Gastroenterology.2.032

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

Jorge E Lopera1,*, Ryan Bitar2, John Walker1, James Elliott3, Katie Strychalski3, Harrison Pollard2, Annie Dang2, Luis Garza2, Carlos Ortiz1, Matthew Parker1, Matthew Z Taon1, Partha Mandal1, Barrett O’Donnell1, Rajeev Suri1, Ho-Young Song1,*
  • 1Department of Radiology, UT Health San Antonio, USA
  • 2Long School of Medicine, UT Health San Antonio, USA
  • 3Department of Lab Animal Resources, UT Health San Antonio, USA
+ Affiliations - Affiliations

Corresponding Author

Jorge E Lopera, Lopera@uthscsa.edu

Received Date: September 23, 2021

Accepted Date: November 03, 2021

Citation:

Lopera JE, Bitar R, Walker J, Elliott J, Strychalski K, Pollard H, et al. Creation of an Ex-vivo Transjugular Intrahepatic Portosystemic Shunt (TIPS) Training Model Using a Perfused Non-cirrhotic Porcine Liver. Arch Gastroenterol Res.2021; 2(3): 79-85.


Copyright: © 2021 Lopera JE, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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. 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.

Keywords

TIPS, Portal Hypertension, Cirrhosis

Recommended Articles

Evaluation and Management of chronic Hypertension in Pregnancy

Chronic hypertension is present in 1-2% of pregnant women. Women with chronic hypertension are at an increased risk of maternal and perinatal complications when compared with normotensive women.

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

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. Transjugular intrahepatic portosystemic shunt (TIPS) creation has demonstrated to be a very effective minimally invasive technique to treat portal hypertension largely supplanting surgical shunts. TIPS, however, is a highly technically demanding procedure with a steep learning curve.

Commentary on: Echocardiography in Pulmonary Arterial Hypertension: Is It Time to Reconsider Its Prognostic Utility?

Pulmonary Arterial Hypertension (PAH) represents a rare but devastating disease due to small pulmonary arterial vessels remodelling and increased pulmonary vascular resistance leading to right ventricular dysfunction, right heart failure and death.

Aldosterone Synthase Inhibitors for Treatment of Hypertension and Chronic Kidney Disease

Aldosterone excess is known to worsen hypertension and kidney function. Three selective aldosterone synthase inhibitors (ASIs) were evaluated in 3 phase 2 trials. In the first study, the ASI baxdrostat 2 mg orally once daily decreased systolic blood pressure (SBP) by 11.0 mmHg compared with placebo after 12 weeks in patients with treatment-resistant hypertension. In the second study including patients with uncontrolled hypertension, placebo-corrected reduction in SBP with lorundrostat 50 mg once daily was 9.6 mmHg after 8 weeks.

Full Text
Cite
Download PDF
Author Information X

About Scientific Archives

Scientific Archives is a global publisher initiated with the mission of ensuring equal opportunity for accessing science to research community all over the world. Spreading research findings with great relevance to all channels without any barrier is our goal. We want to overcome the challenges of Open Access with ensured quality and transparency.

Read More