Feasibility of a porto-intracaval shunt for liver total vascular exclusion in the rabbit: preliminary report

The animals do not tolerate prolonged caval and/or portal clamping which induces negative pathophysiological events such as release of chinines, damage of the intestinal mucosa, and bacterial translocation. In human liver surgery, these problems have been solved by bio-pump for venovenous bypass. In order to find a simple method to reproduce a veno-venous bypass, we developed the porto-intracaval shunt and used it in six adult rabbits. The shunt tested was a self constructed 7-french polyurethane shunt modeled as an inverted Y. The inferior vena cava vein below the diaphragm and below the liver and the portal vein were gently dissected. The two longer branches of the shunt were inserted in the cava vein, while the remaining branch of the Y shunt was inserted in the portal vein. After clamping the hepatic artery, the liver was partially resected in three animals and after 60 min the shunt was removed. The insertion of the shunt was always easy and the animals tolerated well the procedure and the anhepatic phase. Our study has been performed in order to test especially the technical feasibility of this shunt in an effort to reduce portal and caval stasis during the anhepatic phase of the surgical procedures that require caval and portal clamping. The technical feasibility has been obtained but we believe that the materials and dimensions of the shunt have to be perfected and adapted depending on the size of the cava and portal veins. (C) 1999 Wiley-Liss, Inc.