title: Transjugular intrahepatic portosystemic shunt for portal cavernoma with symptomatic portal hypertension in non-cirrhotic patients.
abstract: BACKGROUND
  Portal cavernoma is regarded as a contraindication to transjugular intrahepatic portosystemic shunt (TIPS).
  
  
  OBJECTIVE
  To evaluate the feasibility, safety, and efficacy of TIPS for symptomatic portal hypertension in non-cirrhotic patients with portal cavernoma.
  
  
  METHODS
  Between July 2002 and December 2009, 46 consecutive non-cirrhotic patients with portal cavernoma were admitted to our center. Twenty patients presented with variceal rebleeding (n = 20) and refractory ascites (n = 1), and were treated with TIPS. They were followed until either death or July 2010. Data were compared using the Fisher's exact test or t test.
  
  
  RESULTS
  TIPS were successfully placed in 35% (7/20) of patients via a transjugular approach alone (n = 1), a combined transjugular/transhepatic approach (n = 4), and a combined transjugular/transsplenic approach (n = 2). TIPS were inserted in a large collateral vein in two patients in whom recanalization of the occluded main portal vein was impossible. Procedure-related complication was hepatic capsule perforation in one patient who was cured by medical therapy alone. Shunt dysfunction occurred in two patients, but TIPS revision was failed in one of them. Portosystemic pressure gradient was significantly reduced in TIPS success group (26.3 ± 1.1 vs. 12.4 ± 1.1 mmHg, p < 0.001). The incidence of variceal bleeding in TIPS success group is lower than that in TIPS failure group (14 vs. 69%, p = 0.057). In TIPS success group, two patients died of systemic infection and accident, respectively. In TIPS failure group, two patients died of liver failure.
  
  
  CONCLUSIONS
  TIPS procedures are feasible and safe in selected patients with portal cavernoma. Successful TIPS insertions may decrease the incidence of variceal rebleeding.
authors.affiliation: Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 15 West Changle Road, 710032 Xi'an, China.
authors.forename: Xingshun
authors.initials: X
authors.lastname: Qi
authors.forename: Guohong
authors.initials: G
authors.lastname: Han
authors.forename: Zhanxin
authors.initials: Z
authors.lastname: Yin
authors.forename: Chuangye
authors.initials: C
authors.lastname: He
authors.forename: Jianhong
authors.initials: J
authors.lastname: Wang
authors.forename: Wengang
authors.initials: W
authors.lastname: Guo
authors.forename: Jing
authors.initials: J
authors.lastname: Niu
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.forename: Ming
authors.initials: M
authors.lastname: Bai
authors.forename: Daiming
authors.initials: D
authors.lastname: Fan
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006392:Hemangioma, Cavernous / Q000150:complications / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000379:methods; D015607:Stents; D017211:Treatment Failure; D019043:Vascular Neoplasms / Q000150:complications / Q000601:surgery*; D020246:Venous Thrombosis / Q000209:etiology / Q000601:surgery; D055815:Young Adult