Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with and without cavernous transformation.
BACKGROUND
Treatment options for patients with portal vein thrombosis are limited.


OBJECTIVE
To evaluate the feasibility and efficacy of transjugular intrahepatic portosystemic shunt for portal vein thrombosis with/without cavernomatous transformation.


METHODS
A survey of such patients, referred for transjugular intrahepatic portosystemic shunt between 1994 and 2005, was performed. Success rates, complications, transjugular intrahepatic portosystemic shunt patency and clinical progression were examined.


RESULTS
Transjugular intrahepatic portosystemic shunt was attempted in 28 patients (13 cirrhotics). Indications were: presurgery/transplantation (2), worsening of ascites (2), variceal bleeding (15 - 8 elective), refractory ascites (3), portal biliopathy (3) and portal vein thrombosis complicating Budd-Chiari syndrome (2). Transjugular intrahepatic portosystemic shunt was placed successfully in 19 of 28 (73%); 23 of 28 had complete portal vein thrombosis and 9 of 23 had cavernous transformation and transjugular intrahepatic portosystemic shunt was successfully placed in six of these. In the 19 patients with transjugular intrahepatic portosystemic shunt, the mean follow-up was 18.1 months (range 5-70): six patients had stent revisions; three had liver transplantation, one died of bleeding. Most cirrhotic patients had an improvement in the Child-Pugh score. In the failed transjugular intrahepatic portosystemic shunt group, two of nine died, and three had further bleeding.


CONCLUSIONS
Transjugular intrahepatic portosystemic shunt should be considered for selected patients with symptomatic complete portal vein thrombosis with/without cavernous transformation, as clinical improvement and less rebleeding occur when transjugular intrahepatic portosystemic shunt placement is successful.
Liver Transplantation and Hepatobiliary Unit, Royal Free & University College Medical School, London, UK.
M
M
Senzolo
J
J
Tibbals
E
E
Cholongitas
C K
CK
Triantos
A K
AK
Burroughs
D
D
Patch
D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D015331:Cohort Studies; D004630:Emergencies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D011859:Radiography; D015607:Stents; D017211:Treatment Failure; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*
D000925:Anticoagulants