[Transjugular intrahepatic portosystemic shunt in patients with portal vein thrombosis].
OBJECTIVE
To evaluate the feasibility of TIPS for portal vein thrombosis (PVT) with/without portal vein occlusion/cavernomatous transformation and with/without underlying cirrhosis.


METHODS
13 patients with PVT and refractory ascites (n=7) and variceal bleeding (n = 6) received TIPS placement. The function of the TIPS was controlled with Doppler US at 1 day, 1 week, 4 weeks and 4 months after TIPS placement and subsequently every 3 months. The rates of technical success, revision and mortality after TIPS were evaluated.


RESULTS
The TIPS was successfully placed in 85% (11/13) of the cases. TIPS placement was successful in 87.5% (7/8) of patients with occlusion of the right portal vein and in 100% (5/5) of patients with non-occlusive right portal vein (p > 0.05), in 80% (8/10) of cirrhotic (x/10) and in 100% (3/3) of non-cirrhotic patients (p > 0,05), as well as in one patient with a fresh PVT and in 1 of 2 patients with cavernous transformation. 30 and 14.3% of patients needed a TIPS revision in the first and second year, respectively. No patient with occlusion of the right portal vein required a revision. 54.5% (6/11) of patients died within 6 months. Under exclusion of 4 patients with advanced malignant diseases, the mortality rate was 28.6%.


CONCLUSIONS
TIPS should be considered for selected patients with symptomatic occlusive PVT with/without cavernous transformation and with/without underlying cirrhosis. The frequency of TIPS revision is not greater, and the mortality rate 6 months after PVT recanalization seems to be comparable with that of patients without PVT.
Streitparth
F
F
Institut für Radiologie, Charité Berlin. florian.streitparth@charite.de
Santosa
F
F
Milz
J
J
Gebauer
B
B
Teichgräber
U
U
Hamm
B
B
Hidajat
N
N
D000328:Adult; D000368:Aged; D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D003097:Collateral Circulation / Q000502:physiology; D004621:Embolization, Therapeutic / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006392:Hemangioma, Cavernous / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D015996:Survival Rate; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome