Rotational thrombectomy for endovascular treatment of portomesenteric vein and TIPS thrombosis: Initial single-center experience.

OBJECTIVE

To evaluate the technical feasibility, efficacy, and safety of endovascular rotational thrombectomy (ERT) for treating portomesenteric thrombosis (PMVT) and Transjugular Intrahepatic Portosystemic Shunt thrombosis (TIPS-T) in a real-world clinical setting.

MATERIALS AND

METHODS

In this retrospective single-center study, 23 consecutive patients (n; 16 women; median age 60 years, range 27-80) underwent ERT for PMVT and/or TIPS-T between May 2024 and December 2025. Procedural data, technical outcomes, complications, and follow-up were analyzed.

RESULTS

A total of 26 procedures (N) were performed. ERT was performed as first-line (N = 18, 69.2%) or second-line (N = 8, 30.8%) endovascular approach. Adjunctive thrombectomy techniques were required in 55.6% of procedures. Here, complete recanalization was achieved in 55.6%, partial in 44.4%, yielding a 100% technical success rate. The portosystemic pressure gradient significantly decreased post-procedure (median 17.0 mmHg (IQR 15.0-25.0) to median 7.0 mmHg (IQR 6.0-10.0), p < 0.0001). No device-related adverse events occurred. One hemolysis event (N = 1/26, 6.25%) was likely related to adjunctive hydrodynamic thrombectomy. The 30-day mortality rate was 0.0% (n = 0); overall all-cause mortality during follow-up (median: 137 days; IQR: 83.5-270 days) was 21.7% (n = 5), mainly in patients with Yerdel class 4 thrombosis or advanced liver cirrhosis.

CONCLUSION

Endovascular rotational thrombectomy demonstrated high technical performance and a favorable safety profile for PMVT and TIPS-T. Effective both as a primary and rescue tool, it may represent a valuable addition to the existing mechanical and pharmacomechanical strategies.