Clinical Outcome Of Different Interventional Therapy For Portal Vein Thrombosis In Hepatic Cirrhosis

ObjectivePortal vein thrombosis(PVT)is a common complication in patients with cirrhosis,however,there is no uniform standard for the selection and application of interventional treatment schemes.In this study,through analyzing the indications,effectiveness and safety of different interventional therapies,we hope to provide reference schemes for clinical treatment.MethodsA retrospective analysis was performed on the cirrhosis patients complicated with PVT and receiving interventional treatment in our hospital between Feb,2012 and Jan,2020.All patients signed the informed consent,and the study was allowed by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University.The age,sex,medical history,liver function,preoperative CT or Color Doppler ultrasound,postoperative complications,postoperative CT or Color Doppler ultrasound,improvement of postoperative symptoms,occurrence of complications and regular follow-up were recorded and used to analyze the effectiveness and safety of three kinds of treatments,At the same time,the clinical characteristics of the patients in the three programs were used to analyze the indications of three interventional therapies.Results1.12 patients received thurombolytic therapy by portal vein catheterization.The median time from diagnosis to treatment was 7 days,According to the results of preoperative imaging examination,all patients were diagnosed as acute PVT.11 patients were successfully treated with catheter thrombolysis,with a success rate of 91.7%.The improvement rate of postoperative clinical symptoms was 91.7%,and the operative effective rate was 83.3%,which was significantly higher than the superior mesenteric artery indirect thrombolysis(P=0.03).There was 1 case of hepatic encephalopathy and 1 case of urokinase intolerance after the treatment.During the follow-up,6 of 10 patients with complete or partial recanalization showed different degrees of thrombotic progression,with a recurrence rate of 60.0%,1 of 4 patients without thrombus progression died of liver cancer;1 patient with postoperative thrombotic stability died of liver failure.2.14 patients received indirect thrombolysis via superior mesenteric artery,the median time from diagnosis to treatment was 7 days,according to the results of preoperative imaging examination,all patients were diagnosed as acute PVT.The operation was successful in 14 patients with a success rate of 100%.The improvement rate of postoperative symptoms was71.4%,the operative effective rate was 42.8%,and the incidence of perioperative complications was 14.3%.During the follow-up,1 patient who survived intestinal resection died of hemorrhage at the 7th month after surgery.3 of 6 patients with complete or partial recanalization showed different degrees of thrombotic progression,with a recurrence rate of 50.0%.2 of 4 patients with postoperative thrombotic stability showed thrombotic progression,and died of intestinal necrosis,2 patient did not showed significant progression.3.46 patients received TIPS treatment,the median time from diagnosis to treatment was 183 days,43 cases of PVT were diagnosed with portal hypertension of different degrees,3 patients had a history of PVT,14 patients showed cavernous degeneration of portal vein.The operation was successful in 42 patients with a success rate of 91.4%,the improvement rate of postoperative symptoms was 89.1%,the effective rate of operation was 63.0%,postoperative hemorrhage occurred in 3 cases(6.5%),and hepatic encephalopathy occurred in 6 cases(17.4%).During the follow-up after the operation,11 cases had shunt occlusion,7 patients were successfully recanalized by catheter thrombolysis or balloon and stent angioplasty via shunt,1 patients died of hemorrhage during recanalization,and 3 patients was asymptomatic.1-year survival rate was 82.1%,2-year survival rate was 74.8%,and 3-year survival rate was70.2%.Conclusion1.For cirrhosis complicated with acute PVT,portal vein catheterization thrombolysis can effectively open portal vein and control thrombosis progress,and the clinical effective rate is better than indirect thrombolysis by superior mesenteric artery2.For patients who refuse direct catheter thrombolysis or TIPS,indirect thrombolysis via superior mesenteric artery is helpful to open portal vein blood flow and relieve the clinical symptoms.3.For the cirrhosis patients combined PVT and portal hypertension or spongiform degeneration,TIPS can be used to reduce pressure of portal vein and improve survival rate.