Transjugular intrahepatic portosystemic shunt in patients with chronic portal vein occlusion and cavernous transformation.
OBJECTIVE
To determine the feasibility of transjugular intrahepatic portosystemic shunt (TIPS) creation as a possible salvage intervention in patients with variceal bleeding and chronic portal vein thrombosis with cavernous transformation, refractory to endoscopic therapy.


BACKGROUND
TIPS is technically feasible in partial portal vein occlusion or complete occlusion due to fresh thrombosis. However, when the portal vein occlusion is complete and chronic, placement of TIPS is technically difficult.


METHODS
In a tertiary referral center setting 4 patients with portal hypertension associated complications, received TIPS, as salvage therapy. In all patients a covered stent was placed to the cavernous transformation.


RESULTS
Creation of TIPS to the dilated veins of a cavernous transformation was feasible in patients for whom recanalization of the portal vein was not possible. However, the collaterals need to be suitably wide for placement of TIPS and the high-pressure collaterals should communicate with the varices.


CONCLUSIONS
TIPS should be considered as salvage therapy when endoscopic treatment is unsuccessful in patients with chronic portal vein thrombosis and cavernous transformation.
Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands. a.wils@erasmusmc.nl
Alexandra
A
Wils
Edwin
E
van der Linden
Bart
B
van Hoek
Peter M T
PM
Pattynama
D000328:Adult; D002908:Chronic Disease; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology / Q000601:surgery; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D016879:Salvage Therapy / Q000379:methods; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000601:surgery*