Rf. Mcloughlin et Rn. Rankin, PORTACAVAL SPACE ANATOMY - POTENTIAL IMPLICATIONS FOR PERCUTANEOUS PORTACAVAL SHUNTS, Journal of vascular and interventional radiology, 7(5), 1996, pp. 761-767
PURPOSE: To assess the anatomic feasibility of percutaneous portacaval
shunt formation. MATERIALS AND METHODS: One hundred contrast material
-enhanced computed tomographic (CT) scans were retrospectively reviewe
d. The distance and direction from the inferior vena cava (IVC) to the
main portal vein (MPV) were measured. Anatomic structures intervening
between the IVC and the MPV, and related to the MPV were also noted.
RESULTS: The distance between the IVC and the MPV was less than 1 cm i
n most cases. The direction from the IVC to the upper, middle, and low
er thirds of the MPV was predictable and lay within a relatively narro
w range. At the middle MPV, there were no intervening structures betwe
en the IVC and the MPV in most cases. Intervening structures included
the liver at the upper MPV and nodes at the lower MPV. The most common
structures related to the MPV included the liver, hepatic artery, and
gallbladder (upper MPV); liver, stomach, and pancreas (middle MPV); a
nd pancreas, duodenum, and celiac axis (lower MPV). CONCLUSIONS: These
results indicate a short distance and predictable direction between t
he IVC and MPV. If aberrant vessels and a prominent caudate lobe are e
xcluded, there appears to be a relatively safe cavo-portal route (with
respect to neighboring and intervening structures) at the level of th
e middle MPV. These findings indicate that percutaneous portacaval shu
nting may be worthy of further experimental study.