Systematic review and meta-analysis of trans-jugular intrahepatic portosystemic shunt for cirrhotic patients with portal vein thrombosis

Jian-Bin Zhang; Jie Chen; Jin Zhou; Xu-Ming Wang; Shu Chen; Jian-Guo Chu; Peng Liu; Zhi-Dong Ye

doi:10.12998/wjcc.v9.i19.5179

Systematic review and meta-analysis of trans-jugular intrahepatic portosystemic shunt for cirrhotic patients with portal vein thrombosis

World J Clin Cases. 2021 Jul 6;9(19):5179-5190. doi: 10.12998/wjcc.v9.i19.5179.

Authors

Jian-Bin Zhang¹, Jie Chen¹, Jin Zhou¹, Xu-Ming Wang¹, Shu Chen², Jian-Guo Chu³, Peng Liu¹, Zhi-Dong Ye⁴

Affiliations

¹ Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing 100029, China.
² Department of Interventional Radiology, Affiliated People's Hospital of Inner Mongolia Medical University, Hohhot 010020, Inner Mongolia Autonomous Region, China.
³ Department of Radiology, Air Force Medical Center of PLA, Beijing 100142, China.
⁴ Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing 100029, China. yezhidong6618@yeah.net.

Abstract

Background: Portal vein thrombosis (PVT) was previously a contraindication for trans-jugular intrahepatic portosystemic shunt (TIPS).

Aim: To perform a systematic review and meta-analysis of the current available studies investigating outcomes of TIPS for cirrhotic patient with PVT.

Methods: Multiple databases were systematically searched to identify studies investigating the outcomes of TIPS for cirrhotic patients with PVT. The quality of studies was assessed by Cochrane Collaboration method and Methodological Index for Non-Randomized Studies. The demographic data, outcomes, combined treatment, and anticoagulation strategy were extracted.

Results: Twelve studies were identified with 460 patients enrolled in the analysis. The technical success rate was 98.9% in patients without portal vein cavernous transformation and 92.3% in patients with portal vein cavernous transformation. One-year portal vein recanalization rate was 77.7%, and TIPS patency rate was 84.2%. The cumulative encephalopathy rate was 16.4%. One-year overall survival was 87.4%.

Conclusion: TIPS is indicated for portal hypertension related complications and the restoration of pre-transplantation portal vein patency in cirrhotic patients with PVT. Cavernous transformation is an indicator for technical failure. Post-TIPS anticoagulation seems not mandatory. Simultaneous TIPS and percutaneous mechanical thrombectomy device could achieve accelerated portal vein recanalization and decreased thrombolysis-associated complications, but further investigation is still needed.

Keywords: Liver cirrhosis; Meta-analysis; Portal vein thrombosis; Systematic review; Trans-jugular intrahepatic portosystemic shunt.