Ces radiol. 2020, 74(2):85-92 | DOI: 10.55095/CesRadiol2020/016

TIPS in therapy of acute portal vein thrombosisOriginal article

Pavla Čabelková¹, Antonín Krajina¹, Ondřej Renc¹, Vendelín Chovanec¹, Miroslav Lojík¹, Jan Raupach¹, Tomáš Fejfar², Jan Maňák³, Eva Čermáková⁴

¹ Radiologická klinika LF UK a FN, Hradec Králové

² II. interní klinika LF UK a FN, Hradec Králové

³ III. interní klinika LF UK a FN, Hradec Králové

⁴ Ústav lékařské biofyziky LF UK, Hradec Králové

Aim: Purpose of this retrospective study was to evaluate and to compare the treatment of patients with acute portal vein thrombosis (PVT) in a group with liver cirrhosis and in group without cirrhosis.

Methods: Patients with PVT were selected from the group of patients treated with TIPS procedure between years 2000 and 2019. Patients with chronic PVT and portal cavernoma and patients with tumorous thrombosis were excluded. Patients with acute PVT were divided into two groups - group with liver cirrhosis (LC) and group without cirrhosis. We evaluated size and localization of thrombus. In a group of patients who underwent thrombolysis (TL) for the portal vein (PV) recanalisation we evaluated amount and severity of hemorrhagic complications. We also evaluated primary patency, primary assisted patency and secondary patency of shunt. Thirty-day and 1-year mortality was observed in the group with the LC and without LC and survival was assessed in the whole group and separately in both subgroups. We used the same technique to gain access to PV in all patients. Shunt in the liver parenchyma was created using bare metal stent or stentgraft.

Results: The whole group with acute PVT treated with TIPS consisted of 74 patients. In the group A were 60 patients, 64% of them had partial thrombosis of PV trunk. Majority of this group consisted of men with mean age 58 years. The indications for TIPS were complications of PH (variceal bleeding in 60% and refractory ascites or fluidothorax in 35%). Thrombus was in 32% covered with the stent and in 38% dissolved after treatment with low molecular weight heparin (LMWH). In the group B was 14 patients without LC. They suffered from procoagulation disease such as hepatic veins thrombosis associated with PVT (22 %) and polycytaemia vera (22%). There were more women in this group, mean age was 43 years. These patients had complete thrombosis (86%). In 10 patients from the whole group we had to use the local TL with mechanical thrombectomy to restore the flow in the PV. In this group we observed higher hemorrhagic complication rate comparing to group without TL. All these complications were treated conservatively or endovascularly. Patients in the group with TL had similar rate of 30-day mortality.

Conclusion: Patients with portal vein thrombosis without liver cirrhosis are more frequently younger women with large PV thrombosis presenting with abdominal pain as a main symptom. In these patients using local thrombolysis for recanalisation of PV was more successful. On contrary the patients with PVT and liver cirrhosis were older men with thrombus on the wall of PV trunk. Indication for TIPS was gastrointestinal bleeding and the thrombus was dissolved after TIPS procedure.

Keywords: transjugular intrahepatic portosystemic shunt, portal hypertension, portal vein thrombosis, thrombolysis

Accepted: April 6, 2020; Published: June 1, 2020  Show citation