Figure 1.
Schematic diagram of the magnetic compression system.
The magnetic compression system for portacaval shunt includes A, a parent magnet attached to an anchor wire and B, a daughter magnet. C, The balloon catheter can be inserted into the middle hole of the daughter magnet when the balloon as not inflated with saline. After the balloon is inflated, the daughter magnet can be fixed to the balloon catheter.
Figure 2.
A, The parent magnet was guided to the target position for vessel anastomosis on the inferior vena cava by the wire fixed to one end. B, The daughter magnet was moved to the anastomosis position on the portal vein by the balloon catheter through the incision on the splenic vein. C, After the parent magnet met the daughter magnet, the balloon catheter was withdrawn from the vessel. D, The position of the magnets and the wire after the first surgery. E, Five to 7 days after the first surgery, a rosch-uchida transjugular liver access set inserted in a vascular sheath was introduced into the position of magnet in the inferior vena cava through the right femoral vein. Under X-ray guidance, the needle of the rosch-uchida transjugular liver access set was advanced slowly and ceaselessly along the outline of the magnets and the magnets were detached from the vascular wall. F, The magnets were pulled out of the body by the wire which was fixed to the parent magnet. G, The portal-inferior vena cava shunt was set up.
Figure 3.
Procedure of the magnamosis surgery.
A, Inferior vena cava and portal vein. B, Isolated splenic vein. C, Isolated femoral vein. D, The parent magnet was inserted into the femoral vein with incision. E, The daughter magnet was pulled into the splenic vein. F, The parent magnet clung to the daughter magnet and compressed the anastomosis site.
Figure 4.
Procedure of the second surgery.
A, Under X-ray guidance, the needle of the rosch-uchida transjugular liver access set was advanced slowly and ceaselessly along the outline of the magnets. B, The magnets were pulled out of the body by the wire fixed to the parent magnet (X-ray photograph).
Figure 5.
Portography during the second surgery and after the surgery.
A, During the second surgery, the contrast media can be observed flowing from the portal vein into the inferior vena cava. B, Portal venography revealed that the portosystemic shunt still existed one month after the second surgery.
Figure 6.
Histology of the portal-inferior vena cava shunt.
A, The two magnets stably matched and a large number of fibrous connective tissue can be observed around the anastomosis. B, Mild intimal hyperplasia in the portal vein and the inferior vena cava (H&E staining, 40×). C, Continuity of the vascular adventitia from the portal vein to the inferior vena cava (H&E staining, 40×). D, A large quantity of tidily arranged collagen surrounding the adventitia (Masson’s trichrome stain, 40×). Red arrow: continuous fusion between the portal vein and the vascular adventitia of the inferior vena cava.