Transjugular intrahepatic portosystemic shunt is effective in patients with chronic portal vein thrombosis and variceal bleeding

Xiao-Yan Sun; Guang-Chuan Wang; Jing Wang; Guang-Jun Huang; Chun-Qing Zhang

doi:10.1016/j.hbpd.2020.12.016

Transjugular intrahepatic portosystemic shunt is effective in patients with chronic portal vein thrombosis and variceal bleeding

Hepatobiliary Pancreat Dis Int. 2021 Apr;20(2):128-136. doi: 10.1016/j.hbpd.2020.12.016. Epub 2021 Jan 5.

Authors

Xiao-Yan Sun¹, Guang-Chuan Wang¹, Jing Wang², Guang-Jun Huang¹, Chun-Qing Zhang³

Affiliations

¹ Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China.
² Department of Infectious Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China.
³ Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China. Electronic address: zhangchq0102@163.com.

PMID: 33455864
DOI: 10.1016/j.hbpd.2020.12.016

Abstract

Background: Studies about treatment of patients with chronic portal vein thrombosis (CPVT) are still limited, especially in different types of CPVT. This study aimed to evaluate the effect of transjugular intrahepatic portosystemic shunt (TIPS) in all types of CPVT with variceal bleeding.

Methods: Patients with CPVT who received TIPS treatment between January 2011 and June 2019 were divided into four types according to the extent of thrombosis. All patients had a history of variceal bleeding. The characteristics and clinical parameters were collected and recorded. Data on procedure success rate, variation in portal vein pressure, rebleeding, hepatic encephalopathy (HE), stent stenosis, and overall mortality were analyzed.

Results: A total of 189 patients were included in this study (39 in type 1, 84 in type 2, 48 in type 3, 18 in type 4). The TIPS procedure success rate was 86.2%. The success rate was significantly different among the four types (89.7% vs. 88.1% vs. 83.3% vs. 77.8%, P = 0.001). In the TIPS success group, portal vein pressure was significantly reduced from 27.15 ± 6.59 to 19.74 ± 6.73 mmHg after the procedure (P < 0.001) and the rebleeding rate was significantly lower than that of the fail group (14.7% vs. 30.8%, P = 0.017). In addition, there were no significant differences in HE rate (30.7% vs. 26.9%, P = 0.912) or overall mortality (12.9% vs. 19.2%, P = 0.403) between the TIPS success group and the fail group. In the TIPS success group, we found that the occurrence of HE was significantly different (P = 0.020) among the four types, while there were no significant differences in rebleeding rate (P = 0.669), stent stenosis rate (P = 0.056), or overall mortality (P = 0.690).

Conclusions: TIPS was safe and effective in decreasing portal vein pressure and rebleeding rate in patients with CPVT.

Keywords: Chronic portal vein thrombosis; Hepatic encephalopathy; Transjugular intrahepatic portosystemic shunt; Variceal bleeding.

MeSH terms

Constriction, Pathologic
Esophageal and Gastric Varices* / diagnosis
Esophageal and Gastric Varices* / etiology
Esophageal and Gastric Varices* / surgery
Gastrointestinal Hemorrhage / diagnosis
Gastrointestinal Hemorrhage / etiology
Gastrointestinal Hemorrhage / surgery
Hepatic Encephalopathy
Humans
Portal Vein / diagnostic imaging
Portal Vein / surgery
Portasystemic Shunt, Transjugular Intrahepatic* / adverse effects
Treatment Outcome
Venous Thrombosis / diagnostic imaging
Venous Thrombosis / surgery