Outcomes of Transjugular Intrahepatic Portosystemic Shunt with Portal Vein Recanalization in Cirrhotic Patients with Acute Portal Vein Thrombosis: A Single-Center Study.

PURPOSE: This study aims to evaluate the safety and effectiveness of TIPS-PVR in patients with cirrhosis with acute PVT.

MATERIALS AND

METHODS

A retrospective analysis of cirrhotic patients with acute PVT who underwent TIPS-PVR at a single academic institution. Patients were categorized by PVT etiology and thrombus extent according to AASLD criteria. Outcomes assessed included technical success, one-year patency of the TIPS and porto-mesenteric venous system, need for TIPS reintervention, symptom recurrence, and overall survival. Overall survival was defined as the time from TIPS-PVR to death or last follow-up.

RESULTS

Fifty cirrhotic patients underwent TIPS-PVR for acute PVT. Technical success was 100%. Superior mesenteric vein (SMV) involvement was seen in 30/50 (60%), and splenic vein in 11/50 (22%). At one year, 32 patients had follow-up. Primary patency was 75% (24/32), primary-assisted patency 94% (30/32) for TIPS and 97% (31/32) for the portal vein. Patency rates improved at one year: Main portal vein from 18 to 97% (p < 0.001), SMV from 50 to 91% (p < 0.001), splenic vein from 78 to 100% (p = 0.0108). 9 patients underwent liver transplantation after TIPS-PVR. There were no grade 4 or grade 5 CIRSE adverse events. There were five Grade 6 events after the procedure. Overall survival was 78% at 12 months, with 95% CI 64-87%.

CONCLUSIONS

TIPS-PVR appears to be a safe and effective procedure for cirrhotic patients with acute PVT, offering a viable option for restoring portal venous flow.