Abstract No. 585 The effects of transjugular intrahepatic portosystemic shunt procedures on resolution of portal vein thrombosis

Abstract

Portal vein thrombosis (PVT) is commonly seen in patients with cirrhosis and can result in significant morbidity and mortality. The majority of these patients have contraindications to anticoagulation due to a high risk of bleeding and often undergo transjugular intrahepatic portosystemic shunt (TIPS) for treatment. The effect of TIPS on PVT in patients, who cannot undergo anticoagulation before or after TIPS, has not been well studied. This study investigates the connection between complete or partial recanalization of the portal vein after TIPS deployment. This study looked at patients with PVT who underwent TIPS procedures between 12/2016 and 09/2018. Patients who received any sort of lysis or anticoagulation therapies during TIPS were excluded. Preoperative PVT status was assessed via imaging and intraoperative venography. Post-TIPS PVT status was assessed via ultrasound or MRI between one month and 1 year after the procedure date. A binomial probability calculator was used to challenge the assumption that there is no relation between TIPS and portal vein recanalization. Preliminary data of 10 patients with PVT who underwent a primary TIPS placement without intraoperative thrombolysis and post op anticoagulation showed that 9 out of 10 had a significant reduction or total resolution of their pre-TIPS thrombus burden. The remaining one patient had no change in the extent of thrombosis. A binomial probability calculator showed the likelihood of at least 9 patients having an improvement in thrombus burden to be P < 0.001. Further results are pending and will include any patients with a mesenteric thrombus dating back to 2013. Preliminary findings are promising, demonstrating that 90% of patients had a decrease in thrombus burden with no patients that experienced worsening or progression of thrombosis. Findings would suggest that the TIPS procedure improves PVT. Continued review of patients treated between 2013 and 2016 is necessary before additional conclusions can be made.