[Transjugular intrahepatic portosystemic shunt and combination with percutaneous transhepatic or transsplenic approach for the treatment of portal vein thrombosis with or without cavernomatous transformation]

Abstract

Objective: To evaluate retrospectively the feasibility, efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) or percutaneous transhepatic or transsplenic approach to the portal vein with the combination of TIPS for the treatment of patients with portal vein thrombosis with or without cavernous transformation.

Methods: Sixty-five patients with portal vein thrombosis from July 2002 to August 2007 at our hospital were analyzed retrospectively. Indirect portography through superior mesenteric artery was performed to determine the approaches for TIPS procedure. If the intrahepatic portal vein branches were visualized, TIPS was implemented directly from transjugular approach; if the intrahepatic portal vein branches failed to be visualized, an ultrasound-guided percutaneous transhepatic or transsplenic approach was performed to recanalize the thrombosed portal vein initially followed by TIPS placement to reconstruct the portal venous flow. Efficacy and complications were observed and revision and survival rates monitored during the follow-up.

Results: TIPS were successfully created in 54 of 65 patients with portal vein thrombosis with a success rate of 83.1%. Among them, TIPS were performed directly in 36 of 40 patients; portal vein recanalization were successfully performed via transhepatic access in 15 of 25 patients, and 3 of remaining 5 who failed the transhepatic approach were successfully done from transsplenic access. Then TIPS placement was accomplished with a success rate of 72.0% (18/25). The success rate in cirrhotic patients was 82.4% (42/51) and it was not significant different from those without cirrhosis 85.7% (12/14) (P = 0.766). While the success rate in the patients with cavernous transformation 71.8% (28/39) showed a significant difference compared to that without cavernous transformation 100% (26/26) (P = 0.002). The success rates in portal vein thrombosis and cavernous transformation with or without cirrhosis were 42.9% (18/42) and 83.3% (10/12) respectively, exhibiting a significant difference (P = 0.021). The mortality rate of 30 days post-operation was 3.7% (2/54). From Day 1 to 63 months follow-up, The incidence rate of hepatic encephalopathy was 27.8% (15/54); revision rate 22.2% (12/54); median survival time 31.4 months.

Conclusions: Conventional TIPS or percutaneous transhepatic or transsplenic approach combined with TIPS for the treatment of portal vein thrombosis with or without cavernous transformation are feasible, safe and effective. It is essential to recanalize the thrombosed portal vein initially followed by TIPS placement to reconstruct the portal venous flow.