Final Postprocedural DSA Intrahepatic Branch Patency Predicts Outcomes After Endovascular Recanalization for Acute Non-cirrhotic Portal Vein Thrombosis.

RATIONALE AND

OBJECTIVES

To evaluate whether intrahepatic branch patency on postprocedural digital subtraction angiography (DSA) predicts outcomes after endovascular recanalization for non-cirrhotic portal vein thrombosis (NCPVT).

MATERIALS AND

METHODS

This retrospective study included 122 patients with acute NCPVT who underwent endovascular recanalization. According to final postprocedural DSA findings, patients were classified into patent and occluded intrahepatic branch groups. Early postprocedural outcomes, follow-up adverse events, overall survival, and stent patency were compared. Kaplan-Meier and Cox regression analyses were used to identify factors associated with symptom recurrence.

RESULTS

Postprocedural DSA demonstrated patent intrahepatic branches in 71 patients and occlusion in 51. Compared with the patent group, the occluded group had higher rates of bowel necrosis during hospitalization (17.6% vs 4.2%, P = 0.014), gastrointestinal bleeding (35.7% vs 7.9%, P < 0.001), recurrent abdominal pain (78.6% vs 30.2%, P < 0.001), cavernous transformation of the portal vein (CTPV) (92.9% vs 65.1%, P = 0.001), and secondary intervention (52.4% vs 22.2%, P = 0.002) during follow-up. In multivariable Cox analysis, intrahepatic branch occlusion remained independently associated with symptom recurrence (hazard ratio, 3.08; 95% confidence interval, 1.57-6.03; P = 0.001). Overall survival did not differ significantly between groups. Transjugular intrahepatic portosystemic shunt (TIPS) was not independently associated with overall symptom recurrence, although in patients with intrahepatic branch occlusion it was associated with less gastrointestinal bleeding during follow-up. Stent occlusion occurred in 35 of 49 patients with available follow-up data.

CONCLUSION

Intrahepatic branch patency on postprocedural DSA provides prognostic information after endovascular recanalization for NCPVT. Persistent branch occlusion identifies patients at increased risk for adverse outcomes and may support closer surveillance and individualized postprocedural management.