Transjugular Splenocaval Shunt Creation for the Treatment of Portal Vein Cavernous Transformation with Recurrent Variceal Hemorrhage

Abstract

Purpose: To describe transjugular splenocaval shunt (TSCS) technique and evaluate its feasibility, safety, and effectiveness in patients with cavernous transformation of the portal vein (CTPV) and complete thrombosis of the superior mesenteric vein (SMV).

Materials and methods: In this retrospective analysis, baseline data, procedural outcomes, adverse events, rebleeding episodes, stent patency, hepatic encephalopathy (HE), and survival were retrospectively analyzed in patients with CTPV and recurrent variceal hemorrhage who underwent TSCS.

Results: Eleven patients (median age, 52 years; range, 25-63 years) with CTPV, complete SMV thrombosis, and recurrent variceal hemorrhage were included. Technical success was achieved in all cases, with no procedural mortality. After TSCS, the median splenocaval pressure gradient decreased from 28 mm Hg (range, 23-34 mm Hg) to 7 mm Hg (range, 5-10 mm Hg). During a median follow-up of 22 months (range, 6-39 months), 1 patient experienced rebleeding due to stent stenosis, which resolved after revision. Another patient developed asymptomatic stenosis. One patient developed medically manageable HE, and 3 had transient hyperbilirubinemia. There were no deaths or permanent severe adverse events.

Conclusions: TSCS appears to be a feasible and safe therapeutic option for patients with CTPV and complete SMV thrombosis who are refractory to conventional treatments.