Evaluation of MR/fluoroscopy-guided portosystemic shunt creation in a swine model
Evaluation of MR/fluoroscopy-guided portosystemic shunt creation in a swine model
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DOI：
10.1097/01.rvi.0000228493.07075.fc
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发表时间：
2006-07-01
影响因子：
2.9
通讯作者：
Atalar, Ergin
中科院分区：
文献类型：
--
作者：
Arepally, Aravind;Karmarkar, Parag V.;Atalar, Ergin
目得：为了评估三种不同的经皮门体分流创建磁共振（MR）成像和荧光透视指导下在猪model.MATERIALS和METHODS：在第1阶段的实验，积极的MR血管内针系统创建针跟踪和腔外穿刺。在1.5 T短口径介入MR成像仪上，对10头猪（体重40-45 kg）进行了20次下腔静脉（IVC）/上级肠系膜静脉（SMV）/门静脉（PV）穿刺。使用实时MR成像序列，引导穿刺针通过IVC并进入SMV或PV（N = 20次穿刺）。确认后，在MR成像引导下将导丝推进门静脉系统（N = 20）。在第2阶段，将动物转移至X线透视室，以展开分流管。本研究评价了三种不同的分流管：（i）市售覆膜支架，GO原型桥接支架，和（iii）原型镍钛合金血管吻合器械。结果：在所有20例手术中（100%）均成功完成了MR引导下的IVC/SMV穿刺。所有三个分流器均已展开。覆膜支架固定分流管的机制最差。血管吻合装置和桥接支架具有更牢固的锚定机制，但技术失败率也更高（分别为50%和40%）。当部署成功，血管anastornotic设备导致穿刺部位在nakis.CONCLUSION：经皮分流和血管artastomoses门肠系膜静脉系统和下腔静脉之间成功地创建与使用MR成像和传统的荧光透视相结合的指导。
PURPOSE: To evaluate three different percutaneous portosystemic shunts created with magnetic resonance (MR) imaging and fluoroscopy guidance in a swine model.MATERIALS AND METHODS: In stage 1 of the experiment, an active MR intravascular needle system was created for needle tracking and extracaval punctures. Twenty inferior vena cava (IVC)/superior mesenteric vein (SMV)/portal vein (PV) punctures were performed in 10 swine (weight, 40-45 kg) in a 1.5-T short-bore interventional MR imager. With use of a real-time MR imaging sequence, the needle was guided through the IVC and into the SMV or PV (N = 20 punctures). After confirmation, a wire was advanced into the portal venous system under MR imaging guidance (N = 20). In stage 2, animals were transferred to the radiographic fluoroscopy suite for deployment of shunts. Three different shunts were evaluated in this study: (i) a commercial stent-graft, GO a prototype bridging stent, and (iii) a prototype nitinol vascular anastomotic device. Postprocedural necropsy was performed in all animals.RESULTS: Successful MR-guided IVC/SMV punctures were performed in all 20 procedures (100%). All three shunts were deployed. Stent-grafts had the poorest mechanism for securing a shunt. The vascular anastomotic device and the bridging stent had more secure anchoring mechanisms but also had higher technical failure rates (50% and 40%, respectively). When deployed successfully, the vascular anastornotic device resulted in no bleeding at the sites of punctures at necropsy.CONCLUSION: Percutaneous shunts and vascular artastomoses between the portal mesenteric venous system and IVC were successfully created with use of a combination of MR imaging and conventional fluoroscopy for guidance.