ABSTRACT
Objective To present a preliminary latest procedure for portal hypertension and evaluate the technical feasibility and efficacy of portacaval shunt creation through the percutaneous transhepatic approach in order to make a hemodynamic comparison with that of the classic TIPS.Methods Thirty-eight patients with portal hypertension(36 men;mean age 57 years,range 32～73)were referred for PTPS procedure because of bleeding varices(n=36),intractable ascites(n=1),and hepatopulmonary syndrome(n=1).The severity of liver disease was classified as Child-Pugh B in 27 and C in 11.The PTPS was created by a percutaneous transhepatic puncture into right portal vein and then through left portal vein to the hepatic segment of IVC followed by a prefabrication stress stent-graft placement at the very site.Results Technical and functional success of 100% was achieved in all patients,without related complications.The postprocedural portal vein-IVC gradients mean 13 cmH_2O was achieved with the follow-up period mean 493 days.No recurrence of variceal bleeding and controlled refractory ascites were achieved,and still more with primary patency rate of the involved vascular structure up to 94.8% at 365 days,much better than classic TIPS. Conclusions Portacaval shunt creation using the prefabrication stress stent via percutaneous transhepatic technique is safe and feasible.The compact coincidence was obtained between the stent and the involved vessel with restoration of intrahepatic portal venous bemodynamics together with partial lowering of portal venous pressure and guaranteeing intrahepatic perfusion through right portal vein.It is also obviously to have postoperative prevention of shunt restenoses and lowering postoperative incidence of hepato-encephalopathy.