Transjugular intrahepatic portosystemic shunt combined with agitation thrombolysis in treatment of acute portal vein thrombosis

Abstract

Objective To study the clinical efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with agitation thrombolysis in treatment of acute portal vein thrombosis (PVT) in patients with liver cirrhosis. Methods The clinical data of 37 cirrhotic patients with acute PVT treated from January 2014 to December 2017 at the First Affiliated Hospital of Henan University of Science and Technology was analyzed. There were 20 males and 17 females with age ranging from 29 to 71 years. The patients were divided into the combined group (n=15) and the anticoagulation group (n=22). The combined group was treated with TIPS combined with agitation thrombolysis anticoagulation. The anticoagulation group was treated with anticoagulation. The changes in liver function and hemodynamics of portal vein of the two group were compared. Follow-up studies included postoperative portal vein patency, bleeding and survival rates of patients. Results The postoperative portal vein pressure and maximum burden of PVT in the combined group were significantly lower than those before operation, and the portal vein maximum blood volume and flow velocity of portal vein were significantly higher than those before operation (all P<0.05). At 2 weeks, 6 months and 12 months after operation, the maximum burden of PVT of the combined group was (13.9±5.4)%, (16.1±5.5)% and (13.8±6.2)%, respectively, which was significantly lower than that of the anticoagulant group (84.1±31.3)%, (85.9±27.6)% and (88.2±39.5)% (all P<0.05). At 2 weeks, 6 months and 12 months after operation, the flow velocity of portal vein of the combined group was (21.6±5.7) cm/s, (16.1±6.3) cm/s and (17.6±4.9) cm/s, respectively, which was significantly higher than that of the anticoagulation group (9.7±4.6) cm/s, (8.1±4.3) cm/s and (8.2±3.5) cm/s (all P<0.05). After operation, 3 patients in the combined group developed recurrence of portal vein thrombosis, while the remaining patients had smooth blood flow in the portal vein and shunt. In the anticoagulation group, only 3 patients had unobstructed portal vein blood flow. The cumulative rate of no gastrointestinal bleeding in the combined group was significantly better than the anticoagulant group. The cumulative survival rate of the combined group was also significantly better than the anticoagulation group (P<0.05). Conclusion TIPS combined with agitation thrombolysis was more effective than the traditional anticoagulant therapy in treatment of acute portal vein thrombosis in cirrhotic patients. Key words: Portal vein; Portosystemic shunt, transjugular intrahepatic; Thrombosis; Agitation thrombolysis