Techniques and long-term effects of transjugular intrahepatic portosystemic shunt on liver cirrhosis-related thrombotic total occlusion of main portal vein

Lei Wang,Jiannan Yao,Fuliang He,Xiaoqun Dong,Hongwei Zhao,Zhenhua Fan,Mengfei Zhao,Qiushi Lin,Zhendong Yue,Fuquan Liu,Bin Qiu

doi:10.1038/s41598-017-11455-y

Abstract

Portal vein hypertension (PVH) in liver cirrhosis complicated with portal venous thrombosis (PVT) has been mainly treated with transjugular intrahepatic portosystemic shunt (TIPS). The clinical effects of TIPS have been confirmed, however, no large-scale studies have been focused on technical analyses and a long-term follow-up, especially on thrombotic total occlusion of main portal vein (MPV). To demonstrate critical techniques and clinical outcome of TIPS on liver cirrhosis-related thrombotic total occlusion of MPV, 98 patients diagnosed with liver cirrhosis related thrombotic total occlusion of MPV and treated with TIPS from January 2000 to January 2010 were retrospectively analyzed. Twenty-three (23.5%) patients had MPV (single site) thrombosis, 55 (56.1%) had multiple site-thrombosis (MPV and other), 17 (17.3%) had cavernous transformation of portal vein, and 3 (3.1%) had post-transplant thrombosis. The successful rate of TIPS was 90.7%, without any procedure-related deaths or severe complications. Mean portal pressure was dropped from 33.08 ± 1.38 mmHg preoperatively to 20.18 ± 0.83 mmHg postoperatively (p < 0.001). Collectively, TIPS is safe and effective in treating liver cirrhosis-related thrombotic total occlusion of MPV. This complex procedure requires combination of indirect portography and percutaneous transhepatic portal techniques to increase the rate of success.

Highlights

Techniques and long-term effects of transjugular intrahepatic portosystemic shunt on liver cirrhosis-related thrombotic total occlusion of main portal vein
From January 2000 to January 2010, 98 patients [67 men and 31 women; mean age of 44.8 years] were randomly recruited. Those patients were diagnosed of liver cirrhosis complicated with thrombotic total occlusion of main portal vein (MPV), including 76 with hepatitis B cirrhosis, 4 with hepatitis C cirrhosis, 6 with alcoholic cirrhosis, 1 with primary biliary cirrhosis, 2 with autoimmune cirrhosis, 5 with Budd-Chiari syndrome, and 4 with cryptogenic cirrhosis
The puncture needle was inserted into the thrombus following one-step procedure, but it failed to pass through the thrombus

Summary

Introduction

Techniques and long-term effects of transjugular intrahepatic portosystemic shunt on liver cirrhosis-related thrombotic total occlusion of main portal vein. Portal vein hypertension (PVH) in liver cirrhosis complicated with portal venous thrombosis (PVT) has been mainly treated with transjugular intrahepatic portosystemic shunt (TIPS). The clinical effects of TIPS have been confirmed, no large-scale studies have been focused on technical analyses and a long-term follow-up, especially on thrombotic total occlusion of main portal vein (MPV). Mean portal pressure was dropped from 33.08 ± 1.38 mmHg preoperatively to. TIPS is safe and effective in treating liver cirrhosis-related thrombotic total occlusion of MPV. This complex procedure requires combination of indirect portography and percutaneous transhepatic portal techniques to increase the rate of success. PVT has been treated with various methods[15,16,17] such as anticoagulants, surgery, and interventional therapy depending on acute or chronic onset, anatomical region, grade of thrombosis, and clinical symptoms

Methods

Results

Conclusion