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Clinical Trial
. 2004 Jul 1;10(13):1881-4.
doi: 10.3748/wjg.v10.i13.1881.

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

Zai-Bo Jiang  1 , Hong Shan, Xin-Ying Shen, Ming-Sheng Huang, Zheng-Ran Li, Kang-Shun Zhu, Shou-Hai Guan
Affiliations
Clinical Trial

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

Zai-Bo Jiang et al. World J Gastroenterol. .

Abstract

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

Methods: We performed TIPS for 14 patients with PVTT due to hepatocellular carcinoma (HCC). Of the 14 patients, 8 patients had complete occlusion of the main portal vein, 6 patients had incomplete thrombosis, and 5 patients had portal vein cavernous transformation. Clinical characteristics and average survival time of 14 patients were analysed. Portal vein pressure, ascites, diarrhoea, and variceal bleeding and circumference of abdomen were assessed before and after TIPS.

Results: TIPS was successful in 10 cases, and the successful rate was about 71%. The mean portal vein pressure was reduced from 37.2 mmHg to 18.2 mmHg. After TIPS, the ascites decreased, hemorrhage stopped and the clinical symptoms disappeared in the 10 cases. The average survival time was 132.3 d. The procedure failed in 4 cases because of cavernous transformation in portal vein and severe cirrhosis.

Conclusion: TIPS is an effective palliative treatment to control hemorrhage and ascites due to HCC complicated by PVTT.

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Figures

Figure 1
Figure 1
TIPS procedure in patient with incomplete occlusion of portal vein trunk. A: Main portal vein dilation with eccentric tumor thrombi shoven on enhanced Ctgram. B: Superior mesenteric vein dilation with eccentric filling defect and main portal vein occlusion shown on superior mesenteric vein angiogram. C: Open shunt shown on superior mesenteric vein angiogram after stent implantation. D: Recurrence of symptoms of ascites and diarrhoea 30 d after TIPS and shunt stenosis as wall as segmental filling defects shown on follow-up angiogram.
Figure 2
Figure 2
Occlusive portal vein, dialated superior mesenteric vein, portal vein cavernous transformation, and esophagogastric varices shown on portal vein angiogram after introducing a catheter into superior mesenteric vein.
Figure 3
Figure 3
Main portal vein occlusion, hepatic arteric portal shunt and portal cavernous transformation in a 64-year-old patient with refractory ascites and hematemesis. A: Thin splenic and superior mesenteric vein shown on enhanced CT gram. B: Thin superior mesenteric vein and disordered drainage vein shown on angiogram.
See this image and copyright information in PMC

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