Abstract
TIPS is a well established treatment in selected patients with refractory ascites and/or gastrointestinal bleeding (GIB). Whether TIPS may also be a safe and effective therapeutic option for cirrhotic patients with chronic portal vein thrombosis (PVT) or cavernoma is still not clear. We Investigated the feasibility, safety and efficacy of TIPS in cirrhotic patients with PVT. All consecutive patients with PVT or cavernoma undergoing TIPS placement from April 2014 to April 2019 in GOM Niguarda are here considered. All patients completed at least 6 months of follow-up after TIPS. Of 153 patients undergoing TIPS insertion, 50(32%) had cirrhosis complicated by PVT or cavernoma. In 11 cases(22%) PVT was associated with GIB, in 16 (32%) with ascites. 32(64%) patients had failed recanalization while on anticoagulation, 18 could not be anticoagulated for contraindications. Majority of patients was male (72%), leading etiologies were post-viral and post-alcohol cirrhosis. Median age was 57 years. Median MELD was 14 (range 8–18). TIPS placement was technically feasible in 96%(48/50)of patients. PVT extension is described in table 1. Trans-splenic approach was necessary in 8/50(16%). Early post-TIPS complications were: hemoperitoneum (3 cases,6%), sovra-hepatic vein occlusion (1 case,2%) and systemic infection (6 cases, 12%). During follow-up 94%(15/16) recovered ascites and 15 patients(30%) had at least 1 portosystemic-encephalopathy episode; 33/48 (68%) patients had a complete recanalization and 11/48 (22%) had a partial recanalization. Liver related mortality was 6%. 18 patients were listed to transplantation after achieving portal patency, 6 have been already transplanted, 8 are on waiting list and 4 could be delisted for clinical improvement. TIPS in cirrhotic patients with PVT with or w/o cavernoma is effective and well tolerated. Complete recanalization was achieved in 2 patients out of three, obtaining a clinical beneficial effect on symptomatic PH. Recanalization allowed patients to be listed for LT when needed
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