Transjugular Intrahepatic Portosystemic Shunt and Thrombectomy (TIPS-Thrombectomy) for Symptomatic Acute Noncirrhotic Portal Vein Thrombosis |
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| Institution: | 1. Department of Radiology, Division of Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts;2. Department of Radiology, Division of Abdominal Imaging and Intervention, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts;3. Department of Medicine, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts;1. Department of Radiology, City of Hope Medical Center, Duarte, California;2. Department of Diagnostic Imaging, The Warren Alpert Medical School, Brown University, Providence, Rhode Island;1. Division of Plastic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;2. Section of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;3. Center for Lymphatic Imaging and Interventions, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;1. Department of Radiology, Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut;2. Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St., New Haven, CT 06510;1. Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts;2. Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts;3. Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts;4. Division of Gastroenterology and Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts;5. Division of Hematology and Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts |
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| Abstract: | PurposeTo report the safety and effectiveness of transjugular intrahepatic portosystemic shunt and mechanical thrombectomy (TIPS-thrombectomy) for symptomatic acute noncirrhotic portal vein thrombosis (NC-PVT).Materials and MethodsPatients with acute NC-PVT who underwent TIPS-thrombectomy between 2014 and 2021 at a single academic medical center were retrospectively reviewed. Thirty-two patients were included (men, 56%; median age, 51 years range, 39–62 years]). The causes for PVT included idiopathic (n = 12), prothrombotic disorders (n = 11), postsurgical sequelae (n = 6), pancreatitis (n = 2), and Budd-Chiari syndrome (n = 1). The indications for TIPS-thrombectomy included refractory abdominal pain (n = 14), intestinal venous ischemia (n = 9), ascites (n = 4), high-risk varices (n = 3), and variceal bleeding (n = 2). Variables studied included patient, disease, and procedure characteristics. Patients were monitored over the course of 1-year follow-up.ResultsSuccessful recanalization of occluded portal venous vessels occurred in all 32 patients (100%). Compared with pretreatment patency, recanalization with TIPS-thrombectomy resulted in an increase in patent veins (main portal vein 28% vs 97%, P < .001], superior mesenteric vein 13% vs 94%, P < .001], and splenic vein 66% vs 91%, P < .001]). Three procedure-related adverse events occurred (Society of Interventional Radiology grade 2 moderate). Hepatic encephalopathy developed in 1 (3%) of 32 patients after TIPS placement. At 1-year follow-up, return of symptoms occurred in 3 (9%) of 32 patients: (a) ascites (n = 1), (b) variceal bleeding (n = 1), and (c) intestinal venous ischemia (n = 1). The intention-to-treat 1-year portal vein and TIPS primary and secondary patency rates were 78% (25/32) and 100% (32/32), respectively. Seven patients required additional procedures, and the 1-year mortality rate was 3% (1/32).ConclusionsTIPS-thrombectomy is a safe and effective method for treating patients with symptomatic acute NC-PVT. |
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| Keywords: | AASLD"} {"#name":"keyword" "$":{"id":"kwrd0015"} "$$":[{"#name":"text" "_":"American Association for the Study of Liver Diseases AE"} {"#name":"keyword" "$":{"id":"kwrd0025"} "$$":[{"#name":"text" "_":"adverse event MPV"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"main portal vein NC-PVT"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"noncirrhotic portal vein thrombosis PSG"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"portosystemic gradient PV"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"portal vein PVT"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"portal vein thrombosis SMV"} {"#name":"keyword" "$":{"id":"kwrd0085"} "$$":[{"#name":"text" "_":"superior mesenteric vein TIPS"} {"#name":"keyword" "$":{"id":"kwrd0095"} "$$":[{"#name":"text" "_":"transjugular intrahepatic portosystemic shunt |
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