Efficacy Of Transjugular Intrahepatic Portosystemic Shunt For The Prevention Of Variceal Rebleeding In Cirrhotic Patients With Portal Vein Thrombosis

Background and aims:Portal vein thrombosis (PVT) is defined as the formation of thrombus within the portal trunk, with or without the extension of thrombus into the intrahepatic portal vein branches, splenic vein or mesenteric veins. PVT is a common complication of cirrhosis, however, very few data are available on the natural history and management of PVT in cirrhosis. Esophageal and gastric varices bleeding (EGVB) is a serious complication of cirrhosis, which has high bleeding rate and mortality. It is generally acknowledged that PVT can negatively impact the prognosis of cirrhotic patients with a history of EGVB. Nevertheless, an optimal management of PVT in cirrhotic patients with a history of EGVB is currently not addressed in any consensus. Although several studies suggest transjugular intrahepatic portosystemic shunt (TIPS) not only recanalizes the thrombosed portal vein, but also relieves the symptomatic portal hypertension, the effects of TIPS in cirrhotic patients with PVT is not very clear, especially in patients with a history of EGVB. The aim of this study was to preliminarily evaluate the efficacy of TIPS for the prevention of EGVB in cirrhotic patients with PVT retrospectively.Patients and methods:Thirty-two consecutive cirrhotic patients with a history of EGVB were referred for TIPS between August 2008 and December 2013. The end points evaluated during follow-up included portosystemic pressure gradient (PSG) of pre-TIPS and post-TIPS, variceal rebleeding rate, TIPS dysfunction rate, HE rate and survival rate.Results:TIPS were successfully placed in 86.5% of patients (32/37) without complication or TIPS-related mortality. PSG was reduced from a mean 21.6±4.1 to 14.2±5.2mm Hg after TIPS placement (P=0.000), the decreasing amplitude of PSG reached 35.5%±17.9% from baseline. The 1-and 2-year cumulative variceal rebleeding rates were 12.5% and 50.8%, respectively. The cumulative rate of TIPS dysfunction at 1-and 2-year was 9.4% and 32.0%, respectively. HE occurred in 40.6% (13/32) of patients, and all of them were happened within the first year after TIPS. The 1-and 2-year cumulative survival rate was 79.1% and 73.4%, respectively.Conclusion:TIPS placement is safe, feasible and has a fairly high success rate to prevent EGVB in cirrhotic patients with PVT. Moreover, TIPS may decrease the risk of EGVB and increase survival rate. However, the high incidence of postoperative HE should be paid attention.