title: Transjugular intrahepatic portosystemic shunt with covered stents for hepatocellular carcinoma with portal vein tumor thrombosis.
abstract: OBJECTIVE
  To evaluate transjugular intrahepatic portosystemic shunt (TIPS) with covered stents for hepatocellular carcinoma (HCC) with main portal vein tumor thrombus (PVTT).
  
  
  METHODS
  Eleven advanced HCC patients (all male, aged 37-78 years, mean: 54.3 ± 12.7 years) presented with acute massive upper gastrointestinal bleeding (n = 9) or refractory ascites (n = 2) due to tumor thrombus in the main portal vein. The diagnosis of PVTT was based on contrast-enhanced computed tomography and color Doppler sonography. The patients underwent TIPS with covered stents. Clinical characteristics and average survival time of 11 patients were analyzed. Portal vein pressure was assessed before and after TIPS. The follow-up period was 2-18 mo.
  
  
  RESULTS
  TIPS with covered stents was successfully completed in all 11 patients. The mean portal vein pressure was reduced from 32.0 to 11.8 mmHg (t = 10.756, P = 0.000). Gastrointestinal bleeding was stopped in nine patients. Refractory ascites completely disappeared in one patient and was alleviated in another. Hepatic encephalopathy was observed in six patients and was resolved with drug therapy. During the follow-up, ultrasound indicated the patency of the shunt and there was no recurrence of symptoms. Death occurred 2-14 mo (mean: 5.67 mo) after TIPS in nine cases, which were all due to multiple organ failure. In the remaining two cases, the patients were still alive at the 16- and 18-mo follow-up, respectively.
  
  
  CONCLUSIONS
  TIPS with covered stents for HCC patients with tumor thrombus in the main portal vein is technically feasible, and short-term efficacy is favorable.
authors.affiliation: Jian-Bo Zhao, Chao Feng, Xiao-Feng He, Yan-Hao Li, Yong Chen, Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
authors.forename: Jian-Bo
authors.initials: JB
authors.lastname: Zhao
authors.affiliation: Jian-Bo Zhao, Chao Feng, Xiao-Feng He, Yan-Hao Li, Yong Chen, Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Feng
authors.affiliation: Jian-Bo Zhao, Chao Feng, Xiao-Feng He, Yan-Hao Li, Yong Chen, Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
authors.forename: Qiao-Hua
authors.initials: QH
authors.lastname: Zhu
authors.affiliation: Jian-Bo Zhao, Chao Feng, Xiao-Feng He, Yan-Hao Li, Yong Chen, Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
authors.forename: Xiao-Feng
authors.initials: XF
authors.lastname: He
authors.affiliation: Jian-Bo Zhao, Chao Feng, Xiao-Feng He, Yan-Hao Li, Yong Chen, Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
authors.forename: Yan-Hao
authors.initials: YH
authors.lastname: Li
authors.affiliation: Jian-Bo Zhao, Chao Feng, Xiao-Feng He, Yan-Hao Li, Yong Chen, Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery / Q000628:therapy*; D004932:Esophageal and Gastric Varices / Q000601:surgery; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011169:Portal Vein / Q000473:pathology*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D015607:Stents; D018608:Ultrasonography, Doppler; D020246:Venous Thrombosis / Q000473:pathology / Q000601:surgery*
keywords: Covered stent; Hepatocellular carcinoma; Main portal vein tumor thrombus; Portal hypertension; Transjugular intrahepatic portosystemic shunt