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

Lodhia, Nilesh; Salem, Riad; Levitsky, Josh

doi:10.1007/s10620-009-0735-2

Cited by 17 publications

(16 citation statements)

References 33 publications

(36 reference statements)

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“…In these cases, observation may be justified, because of the appropriate venous inflow from the splenic circulation [19] ; Late PVT with symptomatic manifestations such as acute gastroesophageal bleeding or ascites that should be treated with percutaneous or transjugular transhepatic procedures. Regarding the transjugular experience, Lodhia et al [122] (2010) reported 3 cases of acute PVT occurring years following LT treated with an approach combining a TIPS and mechanical thrombectomy. To reduce the risk of periprocedural pulmonary emboli, the authors performed direct PV thrombolysis prior to placing the TIPS stent in order to allow time for clot dissolution [122] .…”

Section: Summary Of the Clinical Characteristics About Pvtmentioning

confidence: 99%

“…Regarding the transjugular experience, Lodhia et al [122] (2010) reported 3 cases of acute PVT occurring years following LT treated with an approach combining a TIPS and mechanical thrombectomy. To reduce the risk of periprocedural pulmonary emboli, the authors performed direct PV thrombolysis prior to placing the TIPS stent in order to allow time for clot dissolution [122] . Another possibility reported by Guckelberger et al [123] (1999) was described for cases of late PVT with complete recanalization using a systemic low dose recombinant tissue plasminogen activator (rtPA).…”

Section: Summary Of the Clinical Characteristics About Pvtmentioning

confidence: 99%

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Vascular complications following liver transplantation: A literature review of advances in 2015

Piardi¹

2016

WJH

146

159

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Although vascular complications (VCs) following orthotopic liver transplantation (OLT) seldom occur, they are the most feared complications with a high incidence of both graft loss and mortality, as they compromise the blood flow of the transplant (either inflow or outflow). Diagnosis and therapeutic management of VCs constitute a major challenge in terms of increasing the success rate of liver transplantation. While surgical treatment used to be considered the first choice for management, advances in endovascular intervention have increased to make this a viable therapeutic option. Considering VC as a rare but a major and dreadful issue in OLT history, and in view of the continuing and rapid progress in recent years, an update on these uncommon conditions seemed necessary. In this sense, this review comprehensively discusses the important features (epidemiological, clinical, paraclinical, prognostic and therapeutic) of VCs following OLT. Core tip: Although vascular complications (VCs) following orthotopic liver transplantation (OLT) seldom occur, they are the most feared complications with a high incidence of both graft loss and mortality, as

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Section: Summary Of the Clinical Characteristics About Pvtmentioning

confidence: 99%

Section: Summary Of the Clinical Characteristics About Pvtmentioning

confidence: 99%

Vascular complications following liver transplantation: A literature review of advances in 2015

Piardi¹

2016

WJH

146

159

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“…Catheter‐directed percutaneous mechanical and/or pharmacologic thrombolysis or stent placement via a transjugular, transhepatic, and transsplenic approach can be both safe and effective . If not effective, combination of TIPS, mechanical thrombectomy, and angioplasty with or without local thrombolytic therapy may be an alternative . Surgical treatment is considered to be the last therapeutic option …”

Section: Postliver Transplantation Portal Vein Thrombosis and Managementmentioning

confidence: 99%

Nontumoral portal vein thrombosis in patients awaiting liver transplantation

Chen¹,

Turón²,

et al. 2016

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Portal vein thrombosis (PVT) occurs in approximately 2%-26% of the patients awaiting liver transplantation (LT) and is no longer an absolute contraindication for LT. Nearly half of PVT cases are accidentally found during the LT procedure. The most important risk factor for PVT development in cirrhosis may be the severity of liver disease and reduced portal blood flow. Whether other inherited or acquired coagulation disorders also play a role is not yet clear. The development of PVT may have no effect on the liver disease progression, especially when it is nonocclusive. PVT may not increase the risk of wait-list mortality, but it is a risk factor for poor early post-LT mortality. Anticoagulation and transjugular intrahepatic portosystemic shunt (TIPS) are 2 major treatment strategies for patients with PVT on the waiting list. The complete recanalization rate after anticoagulation is approximately 40%. The role of TIPS to maintain PV patency for LT as the primary indication has been reported, but the safety and efficacy should be further evaluated. PVT extension and degree may determine the surgical technique to be used during LT. If a "conventional" end-to-end portal anastomotic technique is used, there is not a major impact on post-LT survival. Post-LT PVT can significantly reduce both graft and patient survival after LT and can preclude future options for re-LT. Liver Transpl 22:352-365, 2016. V C 2015 AASLD.

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“…Several reports suggest that TIPS placement is an effective treatment for addressing early complications of liver transplantation such as PVT, HVOO, and delayed graft function due to ongoing portal hypertension (Fig. ) …”

Section: Transjugular Intrahepatic Portosystemic Shunts In Liver Tranmentioning

confidence: 99%

“…PVT is a rare but severe complication that typically occurs early after OLT and is often related to abnormal venous reconstruction during surgery in patients with preexisting PVT . Interventions for PVT after OLT include surgical thrombectomy, percutaneous thrombolysis, angioplasty, and stent placement, and they are associated with good long‐term outcomes .…”

Section: Transjugular Intrahepatic Portosystemic Shunts For Venous Comentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunts in liver transplant recipients

2013

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The insertion of a transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive procedure used to relieve the signs and symptoms of portal hypertension in patients with liver disease. The most common indications for placement are refractory ascites and variceal hemorrhage. In properly selected candidates, TIPS placement can serve as a bridge to liver transplantation. Expertise in TIPS placement after transplantation has significantly increased, which has allowed the procedure to become a viable option for retransplant candidates suffering the consequences of recurrent portal hypertension due to portal vein thrombosis, recurrent liver disease, or hepatic venous outflow obstruction (HVOO). However, TIPSs in liver transplant recipients are associated with a lower clinical response rate and a higher rate of complications in comparison with patients with native liver disease, and they are, therefore, generally reserved for patients with a Model for End‐Stage Liver Disease (MELD) score ≤ 15 and ≤ 12 in patients with HCV. The role of TIPS placement in nonliver transplant recipients has been well studied in large trials, and it translates well into clinical applicability to candidates for orthotopic liver transplantation (OLT). However, the experience with OLT recipients is heterogeneous and restricted to small series. Thus, we focus here on reviewing the current literature and discussing the proper use of TIPSs in liver transplant recipients. Liver Transpl 20:130‐139, 2014. © 2013 AASLD.

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

Cited by 17 publications

References 33 publications

Vascular complications following liver transplantation: A literature review of advances in 2015

Vascular complications following liver transplantation: A literature review of advances in 2015

Nontumoral portal vein thrombosis in patients awaiting liver transplantation

Transjugular intrahepatic portosystemic shunts in liver transplant recipients

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