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Войти в исследования Cardiovascular and interventional radiology · 2026
Baseline Portal Vein Thrombosis does not Worsen Long-Term Outcomes After Technically Successful TIPS in Cirrhotic Variceal Bleeding: A Single-Center Retrospective Cohort Study.
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Gan Hongying, Jiang Ting, Yu Jiao, Song Zhitao, Zheng Dan, Wu Fan
Аннотация
PURPOSE: To investigate whether the presence of baseline portal vein thrombosis (PVT) and its anatomical subtypes influence long-term outcomes in cirrhotic patients with esophagogastric variceal bleeding (EGVB) undergoing technically successful transjugular intrahepatic portosystemic shunt (TIPS).
MATERIALS AND METHODS: This retrospective cohort study included 140 cirrhotic EGVB patients who underwent successful TIPS between 2017 and 2024. Patients were stratified into groups with (n = 52) and without baseline PVT (n = 88) based on cross-sectional imaging. PVT was subclassified into simple (main trunk only) and mixed (extending to branches/mesenteric veins) types. The primary composite endpoint included all-cause mortality, variceal rebleeding, or shunt dysfunction. Kaplan-Meier analysis and multivariable Cox regression were performed.
RESULTS: Median follow-up was 1286 days. Composite endpoint events occurred in 59 patients (42.1%), with no significant difference between patients with and without PVT (40.4% vs. 43.2%, P = 0.742). Cumulative event-free survival was comparable (log-rank P = 0.650). Within the PVT cohort, no difference was observed between simple and mixed subtypes (HR = 0.80, P = 0.736). Multivariable analysis confirmed that baseline PVT was not an independent predictor of adverse outcomes (HR = 0.92, P = 0.799). However, higher baseline portal pressure gradient (PPG) (HR = 1.09 per mmHg, P = 0.002) and prior history of overt hepatic encephalopathy (OHE) (HR = 3.33, P = 0.040) were identified as independent predictors.
CONCLUSIONS: Baseline PVT, regardless of morphological subtype, does not appear to adversely affect long-term outcomes in the specific cohort of patients in whom TIPS is technically feasible and successful. Higher baseline PPG and history of OHE are primary determinants of long-term prognosis.
MATERIALS AND METHODS: This retrospective cohort study included 140 cirrhotic EGVB patients who underwent successful TIPS between 2017 and 2024. Patients were stratified into groups with (n = 52) and without baseline PVT (n = 88) based on cross-sectional imaging. PVT was subclassified into simple (main trunk only) and mixed (extending to branches/mesenteric veins) types. The primary composite endpoint included all-cause mortality, variceal rebleeding, or shunt dysfunction. Kaplan-Meier analysis and multivariable Cox regression were performed.
RESULTS: Median follow-up was 1286 days. Composite endpoint events occurred in 59 patients (42.1%), with no significant difference between patients with and without PVT (40.4% vs. 43.2%, P = 0.742). Cumulative event-free survival was comparable (log-rank P = 0.650). Within the PVT cohort, no difference was observed between simple and mixed subtypes (HR = 0.80, P = 0.736). Multivariable analysis confirmed that baseline PVT was not an independent predictor of adverse outcomes (HR = 0.92, P = 0.799). However, higher baseline portal pressure gradient (PPG) (HR = 1.09 per mmHg, P = 0.002) and prior history of overt hepatic encephalopathy (OHE) (HR = 3.33, P = 0.040) were identified as independent predictors.
CONCLUSIONS: Baseline PVT, regardless of morphological subtype, does not appear to adversely affect long-term outcomes in the specific cohort of patients in whom TIPS is technically feasible and successful. Higher baseline PPG and history of OHE are primary determinants of long-term prognosis.