Transjugular intrahepatic portosystemic shunt in the treatment of portal vein thrombosis: a critical review of literature

Qi, Xingshun; Han, Guohong

doi:10.1007/s12072-011-9324-5

Cited by 51 publications

(59 citation statements)

References 93 publications

(118 reference statements)

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“…However, pericutaneous approach such as transjugular intrahepatic portosystemic shunt (TIPS) [15,16] may be an effective therapeutics option for non-malignant and non-cirrhotic patients with acute or chronic PVT.…”

Section: Discussionmentioning

confidence: 99%

A Case of liver abscess with Portal Vein Thrombosis caused by α-Hemolytic streptococci

Shizuma¹

2017

J Liver

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Cases of liver abscess complicated by portal vein thrombosis are relatively rare. We report a case of liver abscess caused by α-hemolytic streptococci and complicated by portal vein thrombosis. A 51-year-old male presented with fever and right hypochondralgia. He had watery diarrhoea and bloody stool for over 1 month before presentation. Laboratory tests showed elevated hepatobiliary enzymes, inflammation findings, and anemia. Abdominal imaging revealed liver abscess in the right lobe and thrombosis of right and left branches of the portal vein; no thrombosis was observed in the extrahepatic portal vein. Colonoscopy revealed nonspecific colitis without diverticula or malignancies, and no possible causes of liver abscess except for enterocolitis were detected. Clinical course and laboratory findings indicated that an amoebic liver abscess was unlikely. Blood and pus cultures were positive for α-hemolytic streptococci. A diagnosis of liver abscess caused by α-hemolytic streptococci and complicated by portal vein thrombosis was made. The size of the liver abscess reduced, and inflammation findings resolved with 3 weeks of antibiotic treatment and abscess drainage. Portal vein thrombosis disappeared after 2 week anticoagulant therapy.

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Section: Discussionmentioning

confidence: 99%

A Case of liver abscess with Portal Vein Thrombosis caused by α-Hemolytic streptococci

Shizuma¹

2017

J Liver

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“…The thrombosed portal trunk is progressed to the fibrotic cord (the patients will be included if the interventional radiologists consider that the diameter of a collateral vessel is large enough to place a stent8 17). …”

Section: Methodsmentioning

confidence: 99%

“…A step-wise TIPS strategy has been described in our previous studies 8 17 25. As Viatorr-covered stents are not approved by the State Food and Drug Administration in the Chinese mainland, Fluency covered stents (Bard Peripheral Vascular, Bard, Inc) with a diameter of 8 mm and a length of 6–10 cm will be employed in our study.…”

Section: Methodsmentioning

confidence: 99%

“…Second, if anticoagulation therapy was used in cirrhotic patients with a history of variceal bleeding, the risk or severity of bleeding might be further exacerbated 14 15. Third, the TIPS technique in the presence of PVT is relatively difficult,16 and the procedure-related complications are potentially lethal 17. Owing to the absence of randomised controlled studies, no definite treatment algorithm for the management of PVT in liver cirrhosis has been well established in the Baveno V consensus and recent American Association for the Study of Liver Diseases (AASLD) practice guidelines on the management of vascular disorders of the liver 18 19…”

Section: Introductionmentioning

confidence: 99%

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Transjugular intrahepatic portosystemic shunt for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis: study protocol for a randomised controlled trial

Yin

et al. 2013

BMJ Open

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IntroductionPortal vein thrombosis (PVT) increases the risk of variceal rebleeding in liver cirrhosis. However, the strategy for preventing variceal rebleeding in cirrhotic patients with PVT has not been explored. This study aims to evaluate whether the transjugular intrahepatic portosystemic shunt (TIPS) or conventional therapy is preferable for the prevention of variceal rebleeding in liver cirrhosis patients with PVT.Methods and analysisThis is a randomised controlled trial comparing the safety and efficacy of TIPS versus conventional therapy (ie, endoscopic therapy combined with non-selective β-blockers and anticoagulants) for the prevention of variceal rebleeding in cirrhotic patients with non-tumoral PVT. A total of 50 cirrhotic patients with PVT (thrombus >50% of portal vein lumen occupancy) and a history of variceal bleeding will be stratified according to the Child-Pugh class and degree of PVT, and randomised into the TIPS and conventional therapy groups. The primary objective was to compare the incidence of variceal rebleeding between the two groups. The secondary objectives were to compare the overall mortality, variceal rebleeding-related mortality, portal vein recanalisation and complications between the two groups, and to observe the progression of PVT in patients without portal vein recanalisation.Ethics and disseminationThis study was approved by the ethics committee of Xijing hospital (No. 20110224-5), and was registered at ClinicalTrials.gov (NCT01326949). All participants give written informed consent. The first patient was recruited into our study on 4 June 2011. A total of 29 patients were recruited through 5 March 2013 (14 and 15 patients assigned to the TIPS and conventional therapy groups, respectively). If TIPS is superior to conventional therapy for the prevention of variceal rebleeding in cirrhotic patients with PVT, TIPS might be recommended as the first-line therapy in such patients. But a small sample size potentially limits the generalisation of our conclusions.Trial registrationThis study was registered at ClinicalTrials.gov on 29 March 2011. The trial registration number is NCT01326949.Trial statusThe first patient was recruited into our study on 4 June 2011. A total of 29 patients were recruited through 5 March 2013 (14 and 15 patients assigned to the TIPS and conventional therapy groups, respectively).

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“…In patients with chronic PVT, attempts are made to recanalize the MPV via transjugular intrahepatic access. If this technique fails, the TIPS is placed between a hepatic vein and a large collateral vein (42). PVT can also extend into the SMV and/or SpV, which can result in variable pressures and collateralization in the downstream territories.…”

Section: Cbct For Planning Interventionsmentioning

confidence: 99%

Utility of cone-beam computed tomography in the assessment of the porto-spleno-mesenteric venous system

Karuppasamy

2016

Cardiovasc. Diagn. Ther.

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The common diagnostic tools available to evaluate the porto-spleno-mesenteric venous (PSMV) system provide either good hemodynamic information with limited morphological details [e.g., ultrasonography (US)] or excellent tomographic display of the anatomy with limited information about flow patterns [e.g., multidetector computed tomography (MDCT) and magnetic resonance imaging]. Although catheter-directed selective digital subtraction angiography (DSA) can provide excellent information about flow at a high temporal resolution and can generate images at a high spatial resolution, this technique is often limited by a lack of cross-sectional detail. In the assessment of the PSMV system, DSA is also limited by dilution of contrast and motion artefacts. Combining venous phase cone-beam computed tomography (CBCT) with DSA can generate high-quality tomographic data, which allows detailed evaluation of venous tributaries and flow patterns within the splenic, superior mesenteric, and inferior mesenteric venous systems individually. This enables clinicians to better understand the impact of nonobstructive resistance to flow (e.g., as in patients with cirrhosis) and obstructive resistance to flow (e.g., as in patients with thrombosis) within each system and plan treatment accordingly. In this review, we discuss the limitations of common diagnostic methods and the role venous CBCT in combination with DSA can play in assessing the PSMV system.

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Transjugular intrahepatic portosystemic shunt in the treatment of portal vein thrombosis: a critical review of literature

Cited by 51 publications

References 93 publications

A Case of liver abscess with Portal Vein Thrombosis caused by α-Hemolytic streptococci

A Case of liver abscess with Portal Vein Thrombosis caused by α-Hemolytic streptococci

Transjugular intrahepatic portosystemic shunt for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis: study protocol for a randomised controlled trial

Utility of cone-beam computed tomography in the assessment of the porto-spleno-mesenteric venous system

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