Single-Center Experience of Portal Vein Recanalization and Transjugular Intrahepatic Shunt Placement in Patients with Portovisceral Thrombosis.

PURPOSE: To determine the technical and clinical success rates and outcomes of portal vein recanalization (PVR) and portal and visceral vein recanalization (PVVR) with transjugular intrahepatic portosystemic shunt (TIPS) placement for the management of portal vein thrombosis (PVT), including with thrombus extension into tributary visceral veins (PVVT).

MATERIALS AND

METHODS

This retrospective study included 43 consecutive patients who underwent PVR or PVVR-TIPS placement at a single medical center. Of the 43 patients, 38 (88.4%) had chronic thrombus, and 21 (48.9%) had Yerdel Grade III or IV PVVT. Indications for PVR/PVVR-TIPS included variceal bleeding, refractory ascites, and liver transplant or surgical candidacy for patients with partial or complete occlusion. Evaluated outcomes included technical and clinical success rates, adverse events, main PV and TIPS patency, and reintervention rates. Cox proportional hazards regression analysis was used to evaluate potential predictors of reocclusion and need for reintervention.

RESULTS

The technical and clinical success rates were 97.7% and 92.7%, respectively. Seven patients (16.3%) had adverse events. Over a median follow-up of 10.7 months, Kaplan-Meier analysis demonstrated primary patency rates of 86%, 61%, and 46% at 1, 6, and 12 months, respectively. The primary-assisted patency rates were 94%, 87%, and 74% at 1, 6, and 12 months, respectively. Reinterventions were needed in 18 patients (41.9%). No significant predictors of reocclusion or need for reintervention were identified. Eight patients underwent successful liver transplant; 7 received an end-to-end PV anastomosis.

CONCLUSIONS

PVR/PVVR-TIPS placement is safe, technically feasible, and associated with durable clinical improvement with high patency rates in patients with PVT, including with extension into tributary visceral veins.