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. 2021 Oct 4:8:737984.
doi: 10.3389/fmed.2021.737984. eCollection 2021.

Comparison of Transjugular Intrahepatic Portosystemic Shunt in the Treatment of Cirrhosis With or Without Portal Vein Thrombosis: A Retrospective Study

Hong-Liang Wang  1   2 , Wei-Jie Lu  1 , Yue-Lin Zhang  1   3 , Chun-Hui Nie  1   3 , Tan-Yang Zhou  1   2 , Guan-Hui Zhou  1   2 , Tong-Yin Zhu  1   2 , Bao-Quan Wang  1   2 , Sheng-Qun Chen  1   2 , Zi-Niu Yu  1   2 , Li Jing  1   2 , Jun-Hui Sun  1   2   3
Affiliations

Comparison of Transjugular Intrahepatic Portosystemic Shunt in the Treatment of Cirrhosis With or Without Portal Vein Thrombosis: A Retrospective Study

Hong-Liang Wang et al. Front Med (Lausanne). .

Abstract

Aim: The purpose of our study was to conduct a retrospective analysis to compare the effectiveness of transjugular intrahepatic portosystemic shunts (TIPS) in the treatment of patients with cirrhosis with or without portal vein thrombosis (PVT). Methods: We included a total of 203 cirrhosis patients successfully treated with TIPS between January 2015 and January 2018, including 72 cirrhosis patients with PVT (35.5%) and 131 without PVT (64.5%). Our subjects were followed for at least 1 year after treatment with TIPS. Data were collected to estimate the mortality, shunt dysfunction, and complication rates after TIPS creation. Results: During the mean follow-up time of 19.5 ± 12.8 months, 21 (10.3%) patients died, 15 (7.4%) developed shunt dysfunction, and 44 (21.6%) experienced overt hepatic encephalopathy (OHE). No significant differences in mortality (P = 0.134), shunt dysfunction (P = 0.214), or OHE (P = 0.632) were noted between the groups. Age, model for end-stage liver disease (MELD) score, and refractory ascites requiring TIPS were risk factors for mortality. A history of diabetes, percutaneous transhepatic variceal embolization (PTVE), 8-mm diameter stent, and platelet (PLT) increased the risk of shunt dysfunction. The prevalence of variceal bleeding and recurrent ascites was comparable between the two groups (16.7 vs. 16.7% P = 0.998 and 2.7 vs. 3.8% P = 0.678, respectively). Conclusions: Transjugular intrahepatic portosystemic shunts are feasible in the management of cirrhosis with PVT. No significant differences in survival or shunt dysfunction were noted between the PVT and no-PVT groups. The risk of recurrent variceal bleeding, recurrent ascites, and OHE in the PVT group was generally similar to that in the no-PVT group. TIPS represents a potentially feasible treatment option in cirrhosis patients with PVT.

Keywords: cirrhosis; portal vein thrombosis; shunt dysfunction; survival; transjugular intrahepatic portosystemic shunt.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Comparison of survival of patients with PVT and without PVT who were all treated with TIPS. PVT, portal vein thrombosis; TIPS, transjugular intrahepatic portosystemic shunt.
Figure 2
Figure 2
A 55-year-old male patient was treated with TIPS due to esophagogastric varices bleeding with PVT in the main portal vein and superior mesenteric vein (A–C). The portal venogram before (D) and after (E) stent placement. Four months after the operation, the thrombosis disappeared in the main portal vein and superior mesenteric vein (F–H).
Figure 3
Figure 3
Comparison of cumulative incidence of shunt dysfunction of patients with PVT and without PVT who were all treated with TIPS. PVT, portal vein thrombosis; TIPS, transjugular intrahepatic portosystemic shunt.
See this image and copyright information in PMC

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