Noncavernomatous portal vein thrombosis in hepatic cirrhosis: treatment with transjugular intrahepatic portosystemic shunt and local thrombolysis.
OBJECTIVE
To evaluate the use of the transjugular intrahepatic portosystemic shunt (TIPS) and local, low-dose thrombolysis in the treatment of complete, noncavernomatous portal vein occlusion.


METHODS
TIPS implantation and portal vein recanalization was attempted in seven patients with noncavernomatous portal vein obstruction and recurrent variceal bleeding. TIPS placement was followed by thrombolytic therapy to restore portal venous blood flow. Hemodynamic effects and clinical characteristics after the procedure and during follow-up were assessed.


RESULTS
The implantation of TIPS and the recanalization of the portal vein trunk were successful in all patients. The treatment reduced the portal venous pressure gradient and restored portal blood flow. No bleeding complications were observed.


CONCLUSIONS
TIPS placement and recanalization of the main portal vein is a safe and effective treatment option for patients with liver cirrhosis and noncavernomatous portal vein occlusion.
Blum
U
U
Department of Diagnostic Radiology, University Hospital Freiburg, Germany.
Haag
K
K
Rössle
M
M
Ochs
A
A
Gabelmann
A
A
Boos
S
S
Langer
M
M
D003131:Combined Modality Therapy; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007260:Infusion Pumps; D007262:Infusions, Intravenous; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011169:Portal Vein; D011170:Portasystemic Shunt, Surgical; D015607:Stents; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000209:etiology / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage
D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator