Interventional recanalization therapy in patients with non-cirrhotic, non-malignant portal vein thrombosis: comparison between transjugular versus transhepatic access

Max Seidensticker,Osman Öcal,Jens Ricke,Christian Steib,Michael Köhler,Hauke Heinzow,Mirjam Gerwing,Martin K. Angele,Nabeel Mansour,Sinan Deniz,Moritz Wildgruber

doi:10.1007/s00261-022-03411-w

Abstract

PurposeTo compare the safety and outcome of transjugular versus percutaneous technique in recanalization of non-cirrhotic, non-malignant portal vein thrombosis.MethodsWe present a retrospective bicentric analysis of 21 patients with non-cirrhotic, non-malignant PVT, who were treated between 2016 and 2021 by interventional recanalization via different access routes (percutaneous [PT] vs. transjugular in transhepatic portosystemic shunt [TIPS] technique). Complication rates with a focus on periprocedural bleeding and patency as well as outcome were compared.ResultsOf the 21 patients treated (median age 48 years, range of 19–78), seven (33%) patients had an underlying prothrombotic condition. While 14 (57%) patients were treated for acute PVT, seven (43%) patients had progressive thrombosis with known chronic PVT. Nine patients underwent initial recanalization via PT access and twelve via TIPS technique. There was no significant difference in complete technical success rate according to initial access route (55.5% in PT group vs. 83.3% in TIPS group, p = 0.331). However, creation of an actual TIPS was associated with higher technical success in restoring portal venous flow (86.6% vs. 33.3%, p = 0.030). 13 (61.9%) patients received thrombolysis. Nine (42.8%) patients experienced hemorrhagic complications. In a multivariate analysis, thrombolysis (p = 0.049) and PT access as the first procedure (p = 0.045) were significant risk factors for bleeding.ConclusionInvasive recanalization of the portal vein in patients with PVT and absence of cirrhosis and malignancy offers a good therapeutic option with high recanalization and patency rates. Bleeding complications result predominantly from a percutaneous access and high amounts of thrombolytics used; therefore, recanalization via TIPS technique should be favored.

Highlights

Portal vein thrombosis (PVT) is a rare condition with a reported prevalence of 3.7 per 100.000 population, and half of the cases occur in a patient without liver cirrhosis or malignancy [1]
PT percutaneous access, TIPS transjugular intrahepatic portosystemic shunt, Janus kinase 2 (JAK2) janus kinase 2, MPN myeloproliferative neoplasm, CT computed tomography, PV portal vein, SMV superior mesenteric vein, SV splenic vein patients included were a median of 48 years, ranging from 19 to 78 years at the time of treatment
An underlying prothrombotic condition was identified in seven patients (33%), of these three had a Janus kinase 2 (JAK2) mutation (14%)

Summary

Introduction

Portal vein thrombosis (PVT) is a rare condition with a reported prevalence of 3.7 per 100.000 population, and half of the cases occur in a patient without liver cirrhosis or malignancy [1]. PVT without has better survival rates than PVT in patients with cirrhosis or malignancy [1], it is associated with a significant risk of venous congestion of the gut in the Abdominal Radiology acute period and complications related to portal hypertension in the long term, especially life-threatening variceal bleeding, requiring lifelong specialized care [6, 7]. The rarity of this condition precludes large-scale controlled trials, and the treatment algorithm of non-cirrhotic and nonmalignant PVT has not been standardized. Anticoagulation for six months is recommended in patients with reversible etiologies of PVT, life-long in patients with thrombophilia [8]

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