Analysis of transjugular intrahepatic portosystemic shunt by hemodynamic simulation

Article type: Research Article

Authors: Cao, Junjie^a; | Yao, Zhichao^a; | Huo, Guijun^a | Liu, Zhanao^a | Tang, Yao^a | Huang, Jian^a | Chen, Minxin^b | Ding, Rui^b | Shen, Liming^a | Zhou, Dayong^a;

Affiliations: [a] Department of Vascular Surgery, Gusu School of Nanjing Medical University, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital (HQ), Suzhou, China | [b] Department of Mathematics, Soochow University, Suzhou, China

Correspondence: [*] Corresponding author: Dayong Zhou, Department of Vascular Surgery, Gusu School of Nanjing Medical University, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital (HQ), Suzhou 215002, Jiangsu Province, China. E-mail: zhoudy@njmu.edu.com

Note: [†] These authors contributed equally to the study.

Abstract: BACKGROUND:Transjugular intrahepatic portosystemic shunt (TIPS), which artificially creates a portocaval shunt to reduce portal venous pressure, has gradually become the primary treatment for portal hypertension (PH). However, there is no prefect shunting scheme in TIPS to balance the occurrence of postoperative complications and effective haemostasis. OBJECTIVE:To construct cirrhotic PH models and compare different shunting schemes in TIPS. METHODS:Three cases of cirrhotic PH with different liver volumes were selected for enhanced computed tomography scanning. The models for different shunting schemes were created using Mimics software, and following FLUENT calculation, all the models were imported into the software computational fluid dynamic-post for processing. In each shunting scheme, the differences in portal vein pressure, hepatic blood perfusion and blood flow from the superior mesenteric vein in the shunt tract were compared. The coefficient G was adapted to evaluate the advantages and disadvantages. RESULTS:(1) Concerning the precise location of the shunt tract, the wider the diameter of the shunt tract, the lower the pressure of the portal vein and the lesser the hepatic blood perfusion. Meanwhile, the pressure drop objective was not achieved with the 6 mm-diameter shunting scheme. (2) The 8 mm-diameter shunting scheme through the left portal vein (LPV) had the highest coefficient G. CONCLUSION:The 8 mm-diameter shunting scheme through the LPV may demonstrate a superior effect and prognosis in TIPS procedures.

Keywords: Transjugular intrahepatic portosystemic shunt, computational fluid dynamic, chronic liver disease, hemorrhage, portal pressure

DOI: 10.3233/BME-230020

Journal: Bio-Medical Materials and Engineering, vol. 35, no. 1, pp. 27-37, 2024