title: Transjugular intrahepatic portosystemic shunt for symptomatic portal hypertension in hepatocellular carcinoma with portal vein tumor thrombosis.
abstract: OBJECTIVE
  Transjugular intrahepatic portosystemic shunt (TIPS) represents a major advance in the treatment of complications of portal hypertension. However, this procedure is contraindicated in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT). This study aims to evaluate the safety and efficacy of TIPS in these patients with portal hypertension and determine the predictors of survival after TIPS creation.
  
  
  METHODS
  Between 2005 and 2011, 58 consecutive HCC patients with symptomatic portal hypertension and concomitant PVTT underwent TIPS placement. Procedure-related complications, treatment efficacy of portal hypertension complications and survival were evaluated.
  
  
  RESULTS
  After TIPS, no patient experienced major procedure-related complications such as hemorrhage or contrast extravasation. Portosystemic pressure gradient was decreased by 14 mmHg on average. Refractory ascites was partially or completely resolved in 19 of 20 patients. Hydrothorax was decreased in all of eight patients. Acute variceal bleeding was successfully controlled in all of five patients. Severe diarrhea was controlled successfully in all of nine patients. During the follow-up period (mean, 78.5 days; range, 11-1713), 56 patients died and two patients remained alive. The median survival period after TIPS was 77 days. Multivariate Cox regression analysis showed that ascites (P = 0.026), white blood cell (P = 0.007) and degree of PVTT (P < 0.001) were independent predictors for survival.
  
  
  CONCLUSIONS
  TIPS may be effective for the palliative treatment of portal hypertension in HCC patients with PVTT. Major procedure-related complications were rarely observed. Ascites, white blood cell and degree of PVTT were independently associated with survival.
authors.affiliation: Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases.
authors.forename: Lei
authors.initials: L
authors.lastname: Liu
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhao
authors.forename: Xingshun
authors.initials: X
authors.lastname: Qi
authors.forename: Guohong
authors.initials: G
authors.lastname: Cai
authors.forename: Chuangye
authors.initials: C
authors.lastname: He
authors.forename: Wengang
authors.initials: W
authors.lastname: Guo
authors.forename: Zhanxin
authors.initials: Z
authors.lastname: Yin
authors.forename: Hui
authors.initials: H
authors.lastname: Chen
authors.forename: Xi
authors.initials: X
authors.lastname: Chen
authors.forename: Daiming
authors.initials: D
authors.lastname: Fan
authors.forename: Guohong
authors.initials: G
authors.lastname: Han
keywords: hepatocellular carcinoma; portal hypertension; portal vein tumor thrombosis; therapy; transjugular intrahepatic portosystemic shunt