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Short- and long-term effects of the transjugular intrahepatic portosystemic shunt on portal vein thrombosis in patients with cirrhosis
  1. Angelo Luca1,
  2. Roberto Miraglia1,
  3. Settimo Caruso1,
  4. Mariapina Milazzo1,
  5. Cristina Sapere2,
  6. Luigi Maruzzelli1,
  7. Giovanni Vizzini2,
  8. Fabio Tuzzolino3,
  9. Bruno Gridelli4,
  10. Jaime Bosch5
  1. 1Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
  2. 2Medical Department, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
  3. 3Information Technology Department, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
  4. 4Surgery Department, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
  5. 5Hospital Clinic, Liver Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Spain
  1. Correspondence to Dr Angelo Luca, Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT). Via Tricomi n 1, C.A.P. 90127, Palermo, Italy; aluca{at}ismett.edu

Abstract

Background and aims Portal vein thrombosis (PVT) negatively impacts the prognosis in patients with cirrhosis. The aim of our study was to evaluate the effects of transjugular intrahepatic portosystemic shunt (TIPS) placement in patients with cirrhosis complicated by PVT.

Methods Seventy consecutive cirrhotic patients with non-tumoural PVT treated with TIPS for portal hypertension complications from January 2003 to February 2010 in a tertiary-care centre were followed until last clinical evaluation, liver transplantation, or death.

Results TIPS was successfully placed without major procedure-related complications. After TIPS, the portal venous system was completely recanalised in 57% of patients, a marked decrease in thrombosis was observed in 30%, and no improvement was seen in 13%. 95% of patients with complete recanalisation after TIPS maintained a patent portal vein. Predictors of complete recanalisation were a less severe and extensive PVT, de novo diagnosis of PVT, and absence of gastro-oesophageal varices. At follow-up, 1 patient had recurrence of bleeding, and 2 had spontaneous bacterial peritonitis. The rate of TIPS dysfunction at 12 and 24 months was 38% and 85% for bare stent and 21% and 29% for covered stent (p=0.001), respectively. Occurrence of encephalopathy at 12 and 24 months was 27% and 32%, respectively. Fifteen patients underwent liver transplantation. Survival at 1, 12 and 24 months was 99%, 89% and 81%, respectively.

Conclusion Long-term outcome of non-tumoural PVT in patients with cirrhosis treated with TIPS placement is excellent. Prospective randomised studies should investigate whether TIPS placement is the best therapeutic option in patients with cirrhosis who develops non-tumoural PVT.

  • Cirrhosis
  • thrombosis
  • TIPS
  • anticoagulation
  • thrombolysis
  • hepatobiliary radiology
  • imaging
  • liver transplantation
  • portal hypertension

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Footnotes

  • Competing interests None.

  • Ethics approval The study was approved by our institute's Internal Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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