Comparison of transjugular intrahepatic portosystemic shunt and percutaneous transhepatic catheter thrombolysis on acute portal vein thrombosis

Abstract

Objective To compare the efficacy of transjugular intrahepatic portosystemic shunt(TIPS) and percutaneous transhepatic catheter directed thrombolysis(CDT) on acute portal vein thrombosis(PVT). Methods The clinical data of 34 patients with acute portal vein thrombosis were analyzed retrospectively. Among them, 14 cases were treated with TIPS and catheter contact thrombolysis, 17 cases received percutaneous transhepatic catheter thrombolysis, and 3 cases failed to be operated successfully. The thrombolytic therapeutic time, effect, complications and recurrence of PVT during the follow-up were compared. Results TIPS combined with CDT were successfully created in 14 patients. The mean thrombolytic therapeutic time was 7.2 days, and portal veins were recanalized more than 75.0% by imaging finding in 11 patients (78.6%). Four patients(28.6%) had complications. During follow-up, 1 patient (7.1%) had recurrence of thrombus. In the 17 cases treated by percu-taneous transhepatic catheter thrombolysis, the mean postoperative time of thrombolysis was 10.1 days, portal vein recanalization (>75.0%) examed by X-ray occurred in 6 cases(35.3%), 8 cases experienced complications (47.1%), during the follow-up 7 cases (41.2%) suffered recurrent thrombosis. After TIPS and catheter directed thrombolysis, the thrombolysis time was shortened (P=0.033), the recanalization rate of portal vein (>75%) was higher (P=0.029), and the recurrence rate of thrombus was low (P=0.045). Conclusions Both the two methods are effecive in the treatment of acute PVT, and TIPS combined with CDT may be better. Key words: Portosystemics hunt; Transjugular intrahepatic; Portal vein thrombosis; Catheter directed thrombolysis