title: Portal vein recanalization-transjugularintrahepatic portosystemic shunt using the transsplenic approach to achieve transplant candidacy in patients with chronic portal vein thrombosis.
abstract: OBJECTIVE
  To present the transsplenic route as an alternative approach for portal vein recanalization-transjugular portosystemic shunt (PVR-TIPS) for chronic main portal vein thrombosis (PVT) in potential transplant candidates.
  
  
  METHODS
  In 2013-2014, 11 consecutive patients with cirrhosis-induced chronic main PVT underwent transsplenic PVR-TIPS. All patients had been denied listing for transplant because of the presence of main PVT, a relative contraindication in this center. The patients were followed for adverse events. Portal vein patency was assessed at 1 month by splenoportography and every 3 months subsequently by ultrasound or magnetic resonance imaging. After PVR-TIPS, patients were reviewed (and subsequently listed for transplant) at a weekly multidisciplinary conference.
  
  
  RESULTS
  PVR-TIPS using the transsplenic approach was successful in all 11 patients with no major complications. Median age was 61 years (range, 33-67 y) and 9 of 11 patients (82%) were men. Nonalcoholic steatohepatitis was the leading cause of liver disease in 4 of 11 patients (36%), and hepatitis C was present in 4 of 11 patients (36%). Complete main PVT was found in 8 of 11 patients (73%). Of 11 patients, 4 (36%) had a Model for End-Stage Liver Disease score > 18, and 8 (73%) had a baseline Child-Pugh score of 7-10. Minor adverse events occurred in 2 of 11 patients (fever, encephalopathy). At the end of the procedure, 5 of 11 patients (45%) exhibited some minor remaining thrombus in the portal vein; 3 of the 5 patients (60%) had complete thrombus resolution at 1 month, with the remaining 2 patients having resolution at 3 months (no anticoagulation was needed). Three patients underwent successful liver transplant with end-to-end anastomoses.
  
  
  CONCLUSIONS
  Transsplenic PVR-TIPS is a potentially safe and effective method to treat PVT and improve transplant candidacy.
authors: Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611.
authors: Ali
authors: A
authors: Habib
authors: Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611.
authors: Kush
authors: K
authors: Desai
authors: Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611.
authors: Ryan
authors: R
authors: Hickey
authors: Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611.
authors: Bartley
authors: B
authors: Thornburg
authors: Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611.
authors: Michael
authors: M
authors: Vouche
authors: Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611.
authors: Robert L
authors: RL
authors: Vogelzang
authors: Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611.. Electronic address: r-salem@northwestern.edu.
authors: Riad
authors: R
authors: Salem
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003131:Combined Modality Therapy / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011859:Radiography; D013154:Spleen / Q000601:surgery; D016896:Treatment Outcome; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000175:diagnosis / Q000601:surgery*