Comparison of Transjugular Intrahepatic Portosystemic Shunt in the Treatment of Cirrhosis With or Without Portal Vein Thrombosis: A Retrospective Study

Abstract

Aim: The purpose of our study was to conduct a retrospective analysis to compare the effectiveness of transjugular intrahepatic portosystemic shunts (TIPS) in the treatment of patients with cirrhosis with or without portal vein thrombosis (PVT).Methods: We included a total of 203 cirrhosis patients successfully treated with TIPS between January 2015 and January 2018, including 72 cirrhosis patients with PVT (35.5%) and 131 without PVT (64.5%). Our subjects were followed for at least 1 year after treatment with TIPS. Data were collected to estimate the mortality, shunt dysfunction, and complication rates after TIPS creation.Results: During the mean follow-up time of 19.5 ± 12.8 months, 21 (10.3%) patients died, 15 (7.4%) developed shunt dysfunction, and 44 (21.6%) experienced overt hepatic encephalopathy (OHE). No significant differences in mortality (P = 0.134), shunt dysfunction (P = 0.214), or OHE (P = 0.632) were noted between the groups. Age, model for end-stage liver disease (MELD) score, and refractory ascites requiring TIPS were risk factors for mortality. A history of diabetes, percutaneous transhepatic variceal embolization (PTVE), 8-mm diameter stent, and platelet (PLT) increased the risk of shunt dysfunction. The prevalence of variceal bleeding and recurrent ascites was comparable between the two groups (16.7 vs. 16.7% P = 0.998 and 2.7 vs. 3.8% P = 0.678, respectively).Conclusions: Transjugular intrahepatic portosystemic shunts are feasible in the management of cirrhosis with PVT. No significant differences in survival or shunt dysfunction were noted between the PVT and no-PVT groups. The risk of recurrent variceal bleeding, recurrent ascites, and OHE in the PVT group was generally similar to that in the no-PVT group. TIPS represents a potentially feasible treatment option in cirrhosis patients with PVT.

Efficacy and safety of transjugular intrahepatic portosystemic shunt for the treatment of schistosomiasis-induced portal hypertension: a retrospective case series

“…Among these, the proportion of CTPV in the splenectomy group was 41.2%, which was higher than that in the nonsplenectomy group (15.4%) ( P = 0.080), although the difference was not statistically significant due to the small sample size and other reasons. It is also because of the high number of patients with splenectomy that the overall incidence of PVT in patients of this study was also relatively higher compared to other studies [32,33]. The mechanism by which splenectomy leads to PVT may be correlated with both a hypercoagulable state of blood due to elevated platelets and reduced blood flow velocity due to decreased portal venous blood flow, which together lead to an increased risk of thrombosis.…”

Portal vein thrombosis in liver cirrhosis: An updated overview

“…90 Two studies showed a similar rate of adverse events (mortality and HE) in patients who received TIPS with or without previous PVT. 91,92 Two RCTs on preventing VH in cirrhotic patients with PVT evidenced that TIPS were more effective in preventing rebleeding and eliminating PVT than endoscopic ligation combined with propranolol and anticoagulation, without increasing the risk of HE or other adverse events. 93,94 A meta-analysis was conducted by Rodrigues et al, including 399 patients from 13 studies, to evaluate the efficacy of TIPS in achieving PVT resolution.…”

“…Fortunately, with the maturity of TIPS technology, the success rate after TIPS has also been greatly improved 90 . Two studies showed a similar rate of adverse events (mortality and HE) in patients who received TIPS with or without previous PVT 91,92 . Two RCTs on preventing VH in cirrhotic patients with PVT evidenced that TIPS were more effective in preventing rebleeding and eliminating PVT than endoscopic ligation combined with propranolol and anticoagulation, without increasing the risk of HE or other adverse events 93,94 .…”

Transjugular intrahepatic portosystemic shunt for portal hypertension: 30 years experience from China

“…Several Chinese studies on TIPS for PVT have been published (Table 2). 37,61,62,63,67,68,69,70,71,72,73,74,75 Between series, there are differences in PVT stage and acuity, TIPS techniques and additional procedures used to attain portal vein recanalization. TIPS, if placed successfully, is highly effective in the prevention and treatment of PVT, resulting in a recanalization between 67% and 100% 37,62,63,67,68,69,70,71 .…”