Department of Applied Mechanics, Sichuan University, Chengdu 610065, China; Sichuan University Yibin Park / Yibin Institute of Industrial Technology, Yibin 644000, China.
Department of Gastroenterology and Hepatology, Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, Chengdu, China.
J Biomech. 2022 Oct;143:111303. doi: 10.1016/j.jbiomech.2022.111303. Epub 2022 Sep 15.
Transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment for portal hypertension (PH). The current study aimed to investigate the effect of stent position on post-TIPS hemodynamic performance using computational fluid dynamics. Patient-specific pre- and post-TIPS models were reconstructed from CT images of two patients, then virtual TIPS models were created by shifting the portal vein (PV) entry site of the stent. Although there were marginal differences the effects of left-sided and right-sided TIPS on post-TIPS portal pressure and shunting flow, right-sided TIPS resulted in a greater proportion of superior mesenteric vein (SMV) flow diverting to stents compared to that for left-sided TIPS. The results also demonstrated that the nearer the entry site of stent to the portal venous bifurcation, the greater and more stable the shunting blood flow. These results suggest that the entry site of the stent should be as close to the portal vein bifurcation as possible during TIPS. TIPS on the right branch of the portal vein may be more likely to result in post-TIPS hepatic encephalopathy than that on the left branch.
经颈静脉肝内门体分流术（TIPS）是治疗门静脉高压（PH）的有效方法。本研究旨在使用计算流体动力学研究支架位置对 TIPS 后血流动力学性能的影响。从两名患者的 CT 图像重建了患者特异性 TIPS 前后模型，然后通过改变支架的门静脉（PV）入口位置创建了虚拟 TIPS 模型。尽管左、右 TIPS 对 TIPS 后门静脉压力和分流流量的影响存在微小差异，但与左 TIPS 相比，右 TIPS 导致更多的肠系膜上静脉（SMV）血流分流至支架。结果还表明，支架入口越靠近门静脉分叉，分流血流越大且越稳定。这些结果表明，在 TIPS 过程中，支架的入口应尽可能靠近门静脉分叉。与左支 TIPS 相比，门静脉右支 TIPS 更有可能导致 TIPS 后肝性脑病。
