title: Transjugular intrahepatic portosystemic shunt may be superior to conservative therapy for variceal rebleeding in cirrhotic patients with non-tumoral portal vein thrombosis: a hypothesis.
abstract: The presence of occlusive portal vein thrombosis (PVT) greatly changes the natural history of liver cirrhosis, because it not only significantly increases the incidence of variceal rebleeding but also negatively influences the survival. However, due to the absence of strong evidence, no standard treatment algorithm for the secondary prophylaxis of variceal bleeding in cirrhotic patients with non-tumoral PVT has been established. Previous randomized controlled trials have demonstrated that transjugular intrahepatic portosystemic shunt (TIPS) can significantly decrease the incidence of variceal rebleeding in cirrhotic patients without PVT, compared with conservative therapy (i.e., endoscopic plus pharmacological therapy). Further, several large cohort studies have confirmed that TIPS can effectively prevent variceal rebleeding in cirrhotic patients with non-tumoral PVT. On the other hand, TIPS can facilitate recanalizing the thrombosed portal vein by endovascular manipulations, even in the presence of cavernous transformation of the portal vein (CTPV). More importantly, successful TIPS insertions can maintain the persistent portal vein patency, and avoid thrombus extension into the portal venous system. By comparison, anticoagulation therapy can achieve portal vein recanalization only in patients with partial PVT, but not in those with occlusive PVT or CTPV, and the use of anticoagulants may aggravate the risk of variceal bleeding in cirrhotic patients with a history of variceal bleeding. Collectively, we hypothesize that TIPS may be superior to conservative therapy for the prevention of variceal rebleeding in cirrhotic patients with non-tumoral PVT. Randomized controlled trials should be conducted to evaluate the survival benefit of TIPS in these patients.
authors: Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
authors: Xingshun
authors: X
authors: Qi
authors: Guohong
authors: G
authors: Han
authors: Chuangye
authors: C
authors: He
authors: Zhanxin
authors: Z
authors: Yin
authors: Hongbo
authors: H
authors: Zhang
authors: Jianhong
authors: J
authors: Wang
authors: Jielai
authors: J
authors: Xia
authors: Hongwei
authors: H
authors: Cai
authors: Zhiping
authors: Z
authors: Yang
authors: Ming
authors: M
authors: Bai
authors: Kaichun
authors: K
authors: Wu
authors: Daiming
authors: D
authors: Fan
mesh_terms: D006470:Hemorrhage / Q000517:prevention & control / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications; D008954:Models, Biological; D011169:Portal Vein / Q000473:pathology*; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D014648:Varicose Veins / Q000517:prevention & control / Q000601:surgery*; D020246:Venous Thrombosis / Q000150:complications* / Q000601:surgery