Successful recanalization of portal vein thrombosis before liver transplantation using transjugular intrahepatic portosystemic shunt

Liatsos, Christos; Vlachogiannakos, John; Patch, David; Tibballs, Jonathan; Watkinson, A.; Davidson, Brian R; Rolles, K; Burroughs, Andrew K.

doi:10.1053/jlts.2001.23914

Cited by 28 publications

(20 citation statements)

References 26 publications

(33 reference statements)

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“…This has been reported in several small series where TIPS was performed for PVT in patients ultimately undergoing orthotopic liver transplantation and was confirmed in our patients. 17,18 Technical success in these 9 patients was 100% with 85.7% patency of all veins. While a TIPS was successfully placed and functioning in 1 patient with complete PVT and cavernous transformation, the patient's portal vein never recanalized despite mechanical thrombectomy, thrombolytics, and anticoagulation.…”

Section: Discussionmentioning

confidence: 89%

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The role of TIPS for portal vein patency in liver transplant patients with portal vein thrombosis

et al. 2006

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The purpose of this research was to study the efficacy and outcomes of transjugular intrahepatic shunt (TIPS) in end-stage liver disease (ESLD) patients with portal vein thrombosis (PVT) eligible for orthotopic liver transplant. Nine consecutive patients with PVT underwent TIPS as a nonemergent elective outpatient procedure. The primary indication for TIPS was to maintain portal vein patency for optimal surgical outcome. Eight patients underwent contrast enhanced computed tomography (CT) and 1 magnetic resonance imaging diagnosing PVT. Shunt creation was determined by available targets at the time of TIPS and by prior imaging. Patients were followed with portography, ultrasound, CT, or magnetic resonance imaging, and the luminal occlusion was estimated before and after TIPS. Primary endpoints were transplantation, removal from the transplant list, or death. Stabilization, improvement, or complete resolution of thrombosis was considered successful therapy. Failures included propagation of thrombosis or vessel occlusion, and poor surgical anatomy due to PVT. Of 9 patients with PVT, TIPS was successfully placed in all patients without complication or TIPS-related mortality. Eight of 9 patients (88.8%) had improvement at follow-up. One patient failed therapy and re-thrombosed. Two patients (22.2%) were transplanted without complication and had no PVT at the time of transplant. Eight of 9 patients were listed for transplant at the time of their TIPS. Eight of 9 PVTs were nonocclusive. Four of 9 patients (44%) had evidence of cavernous transformation. Two patients expired during follow-up 42 and 44 months after TIPS. Three patients remain on the transplant list. One patient has not been listed due to nonprogression of disease. One patient has been removed from the transplant list because of comorbid disease. In conclusion, TIPS is safe and effective in patients with PVT and ESLD requiring transplant. Patients can be successfully transplanted with optimal surgical anatomy. Liver Transpl 12: 1544-1551, 2006.

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Section: Discussionmentioning

confidence: 89%

“…In 2001, Liatsos et al reported 2 patients, both with PVT and extension into the superior mesenteric vein. 17 Both patients underwent successful TIPS and received orthotopic liver transplant at 31 and 27 days, respectively. Portal veins were patent at the time of transplant, and both patients left the hospital without complication.…”

Section: Discussionmentioning

confidence: 99%

The role of TIPS for portal vein patency in liver transplant patients with portal vein thrombosis

et al. 2006

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“…Previous case reports have validated the safety and efficacy of TIPS in recanalizing the PV system prior to OLT, mainly to allow for patent portal flow at the time of transplantation and reduce the need for intraoperative thrombectomy and risk of rethrombosis [5,[18][19][20][21][22]. Murad et al demonstrated that the degree of extension of thrombosis into the splanchnic venous bed directly correlated with decreased survival [20].…”

Section: Resultsmentioning

confidence: 99%

Transjugular Intrahepatic Portosystemic Shunt with Thrombectomy for the Treatment of Portal Vein Thrombosis After Liver Transplantation

2009

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“…It has been shown that successful TIPS is equally efficacious for cessation of hemorrhage in patients with complete PVT and variceal hemorrhage in comparison with patients with patent vasculature 9–11. More recently, TIPS has been placed specifically for the treatment of PVT to decompress portal hypertension and restore portal flow 8, 12, 13…”

Section: Discussionmentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunt to keep vein open

et al. 2009

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Compared to a surgical shunt, a transjugular intrahepatic portosystemic shunt (TIPS) is a less invasive means of lowering portal venous pressure in patients with cirrhosis experiencing complications of portal hypertension, with relatively low procedure-related morbidity. Presently, the most common indications for TIPS placement are acute variceal bleeding and refractory ascites. The number of other indications is growing, but many are still controversial. We present a patient with partial portal vein thrombosis (PVT) who received TIPS to maintain portal vein patency when it was suspected that complete PVT was imminent. The TIPS was able to preserve the remaining portal flow until successful liver transplantation (LT) 3 months later. CASE REPORTWe evaluated a 58-year-old Caucasian male for LT who had end-stage liver disease secondary to cryptogenic cirrhosis. His medical history was notable for previous spontaneous bacterial peritonitis and ascites requiring frequent large-volume paracenteses. During transplant evaluation, he underwent contrast-enhanced computed tomography, which demonstrated nonoccluding thrombus in the portal vein ( Fig. 1) with extension into the right portal vein branch, superior mesenteric vein, and splenic vein (Fig. 2). To prevent complete PVT and improve his ascites, the patient underwent successful TIPS placement with a 10 mm ϫ 94 mm Wallstent, achieving a postshunt pressure gradient of 12 mm Hg. As an additional precaution, the patient was placed on warfarin, maintaining a therapeutic international normalized ratio between 2.6 and 2.9. Although his degree of hepatic encephalopathy increased after the procedure, his ascites improved, and he remained otherwise stable until transplantation 3 months later.At the time of LT, approximately 2 L of ascites was removed, and the patient had adhesions indicating recent spontaneous bacterial peritonitis. The portal vein was dissected beyond the bifurcation, and this revealed a thrombus in the portal vein completely occluding the left portal branch, extending into the right branch, and surrounding the TIPS in the main portal vein. However, the TIPS, which extended from the right portal vein branch into the main portal vein, and the associated segment of vein proximal to the TIPS were patent (Fig. 3). The thrombus had therefore extended since prior imaging, as it was now completely occluding the left branch of the portal vein. The operation was performed without complication, and the patient was transferred to a rehabilitation facility 2 weeks after LT and continues to do well. DISCUSSIONAlthough PVT is no longer an absolute contraindication to LT, its presence can have an impact on morbidity and mortality prior to and following LT. Besides contributing to the progression of portal hypertension and its sequelae before LT, PVT increases the complexity of LT itself. The operative time, rate of reoperation, requirement for red blood cell transfusion, and length of hospital stay are increased in patients with PVT.

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Successful recanalization of portal vein thrombosis before liver transplantation using transjugular intrahepatic portosystemic shunt

Cited by 28 publications

References 26 publications

The role of TIPS for portal vein patency in liver transplant patients with portal vein thrombosis

The role of TIPS for portal vein patency in liver transplant patients with portal vein thrombosis

Transjugular Intrahepatic Portosystemic Shunt with Thrombectomy for the Treatment of Portal Vein Thrombosis After Liver Transplantation

Transjugular intrahepatic portosystemic shunt to keep vein open

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