Transjugular intrahepatic portosystemic shunt for palliative treatment of portal hypertension secondary to portal vein tumor thrombosis

Jiang, Zai-bo; Song, Hong; Shen, Xiu‐Yu; Huang, Mingsheng; Li, Zhengran; Zhu, Kangshun; Guan, Sheng

doi:10.3748/wjg.v10.i13.1881

Cited by 49 publications

(33 citation statements)

References 26 publications

(6 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…29 In addition, portal venous thrombosis can lead to complications of portal hypertension such as ascites, variceal hemorrhage, and worsening hepatic function in HCC patients. 30 Tumor burden had also been shown to be an important prognostic indicator, but the cutoff used in previous studies has varied from more than 5 cm diameter of the largest nodule to a tumor involving more than 50% of the liver. 31,32 As expected, patients who were eligible for some form of treatment had better survival than those who were too moribund for any treatment.…”

Section: Discussionmentioning

confidence: 99%

Prognosis of hepatocellular carcinoma: Comparison of 7 staging systems in an American cohort

et al. 2005

View full text Add to dashboard Cite

Currently there is no consensus which staging system is best in predicting the survival of patients with hepatocellular carcinoma (HCC). The aims of this study were to identify independent predictors of survival and to compare 7 available prognostic staging systems in patients with HCC. A total of 239 consecutive patients with cirrhosis and HCC seen between January 1, 2000, and December 31, 2003, were included. Demographic, laboratory, and tumor characteristics and performance status were determined at diagnosis and before therapy. Predictors of survival were identified using the Kaplan-Meir test and the Cox model. Sixty-two percent of patients had hepatitis C, 56% had more than 1 tumor nodule, 24% had portal vein thrombosis, and 29% did not receive any cancer treatment. At the time of censorship, 153 (63%) patients had died. The 1-and 3-year survival of the entire cohort was 58% and 29%, respectively. The independent predictors of survival were performance status (P < .0001), MELD score greater than 10 (P ‫؍‬ .001), portal vein thrombosis (P ‫؍‬ .0001), and tumor diameter greater than 4 cm (P ‫؍‬ .001). Treatment of HCC was related to overall survival. The Barcelona Clinic Liver Cancer (BCLC) staging system had the best independent predictive power for survival when compared with the other 6 prognostic systems. In conclusion, performance status, tumor extent, liver function, and treatment were independent predictors of survival mostly in patients with cirrhosis and HCC. The BCLC staging system includes aspects of all of these elements and provided the best prognostic stratification for our cohort of patients with HCC. ( H epatocellular carcinoma (HCC) is the fifth most common tumor worldwide. In the United States, the incidence of HCC has been rising, 1 and it is the tumor with the largest increase in incidence over the last 12 years. 2 Furthermore, the overall survival of patients with HCC has not improved over the last 20 years, with the incidence rate almost equal to the death rate. 3 It is projected that the increase in incidence of HCC will continue over the next 20 years in the United States. 4 Therefore, it is important to understand the factors that predict survival of patients with HCC.

show abstract

Section: Discussionmentioning

confidence: 99%

Prognosis of hepatocellular carcinoma: Comparison of 7 staging systems in an American cohort

et al. 2005

View full text Add to dashboard Cite

show abstract

“…Moreover, TACE will inevitably embolize some part of the blood supplies of normal liver tissues and increase the risk of liver failure. On the other hand, the portal vein pressure is rising with development of PVTT, which increases the risk of esophageal and gastric bleeding and indirectly leads to death [11]. Therefore, opening the occlusion of the portal vein caused by PVTT and reperfusing the portal vein could improve the success of TACE, and this could be achieved using portal vein stenting (PVS) [12–14].…”

Section: Introductionmentioning

confidence: 99%

Portal Vein Stenting Combined with Iodine-125 Seeds Endovascular Implantation Followed by Transcatheter Arterial Chemoembolization for Treatment of Hepatocellular Carcinoma Patients with Portal Vein Tumor Thrombus

Sun

Zhou

Zhu

et al. 2016

BioMed Research International

View full text Add to dashboard Cite

Aim was to assess the therapeutic value of portal vein stenting (PVS) combined with iodine-125 seed (125I seed) strand endovascular implantation followed by transcatheter arterial chemoembolization (TACE) for treating patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT). This was a retrospective study of 34 patients aged 29–81 years, diagnosed HCC with PVTT, and treated with PVS combined with 125I seed strand endovascular implantation followed by TACE between January 2012 and August 2014. Survival, stent patency, technical success rate, complications related to the procedure, and adverse events were recorded. The technical success rate was 100%. No serious procedure-related adverse event was recorded. The median survival was 147 days. The cumulative survival rates and stent patency rates at 90, 180, and 360 days were 94.1%, 61.8%, and 32.4% and 97.1% (33/34), 76.9% (24/34), and 29.4% (10/34), respectively. PVS combined with 125I seed strand endovascular implantation followed by TACE is feasible for patients with HCC and PVTT. It resulted in appropriate survival and stent patency, with no procedure-related adverse effects.

show abstract

“…Thrombotic occlusion of the portal vein increases the difficulty of the procedure and has prompted several variations in technique to improve technical success [7, 9–11]. However, when the thrombosis is chronic and associated with cavernous transformation, the success of TIPS has remained limited.…”

Section: Discussionmentioning

confidence: 99%

“…However, when the thrombosis is chronic and associated with cavernous transformation, the success of TIPS has remained limited. In such patients, Jiang et al reported a 20% (1/5) success rate, with less symptomatic improvement and shorter survival time than noncavernous patients [7]. Walser et al failed in both patients they attempted (0/2) [6].…”

Section: Discussionmentioning

confidence: 99%

“…The occluded portal vein becomes difficult to access by the transjugular route, and even if the portal vein or one of the collaterals is accessed, wire passage across the occluded segment may be difficult or impossible [6]. Some authors have considered cavernous transformation to be a contraindication to TIPS placement [2, 3, 6, 7]. In this report, we describe a novel technique which may increase the technical success of the TIPS procedure in these patients.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

TIPS Placement via Combined Transjugular and Transhepatic Approach for Cavernous Portal Vein Occlusion: Targeted Approach

Jourabchi

McWilliams

Lee

et al. 2013

Case Reports in Radiology

View full text Add to dashboard Cite

Purpose. We report a novel technique which aided recanalization of an occluded portal vein for transjugular intrahepatic portosystemic shunt (TIPS) creation in a patient with symptomatic portal vein thrombosis with cavernous transformation. Some have previously considered cavernous transformation a contraindication to TIPS. Case Presentation. 62-year-old man with chronic pancreatitis, portal vein thrombosis, portal hypertension and recurrent variceal bleeding presents with melena and hematemesis. The patient was severely anemic, hemodynamically unstable, and required emergent portal decompression. Attempts to recanalize the main portal vein using traditional transjugular access were unsuccessful. After percutaneous transhepatic right portal vein access and navigation of a wire through the occluded main portal vein, an angioplasty balloon was inflated at the desired site of shunt takeoff. The balloon was targeted and punctured from the transjugular approach, and a wire was passed into the portal system. TIPS placement then proceeded routinely. Conclusion. Although occlusion of the portal vein increases difficulty of performing TIPS, it should not be considered an absolute contraindication. We have described a method for recanalizing an occluded portal vein using a combined transhepatic and transjugular approach for TIPS. This approach may be useful to relieve portal hypertension in patients who fail endoscopic and/or surgical therapies.

show abstract

Transjugular intrahepatic portosystemic shunt for palliative treatment of portal hypertension secondary to portal vein tumor thrombosis

Abstract: AIM:To evaluate the palliative therapeutic effects of transjugular intrahepatic portosystemic shunt (TIPS) in portal vein tumor thrombosis (PVTT) complicated by portal hypertension.

Cited by 49 publications

References 26 publications

Prognosis of hepatocellular carcinoma: Comparison of 7 staging systems in an American cohort

Prognosis of hepatocellular carcinoma: Comparison of 7 staging systems in an American cohort

Portal Vein Stenting Combined with Iodine-125 Seeds Endovascular Implantation Followed by Transcatheter Arterial Chemoembolization for Treatment of Hepatocellular Carcinoma Patients with Portal Vein Tumor Thrombus

TIPS Placement via Combined Transjugular and Transhepatic Approach for Cavernous Portal Vein Occlusion: Targeted Approach

Contact Info

Product

Resources

About