title: Percutaneous transhepatic balloon-assisted transjugular intrahepatic portosystemic shunt for chronic, totally occluded, portal vein thrombosis with symptomatic portal hypertension: procedure technique, safety, and clinical applications.
abstract: OBJECTIVE
  To introduce a modified transjugular intrahepatic portosystemic shunt (TIPS) procedure, percutaneous transhepatic balloon-assisted TIPS (BA-TIPS), and to evaluate its feasibility and efficacy in patients with chronic totally occluded portal vein thrombosis (CTO-PVT) with symptomatic portal hypertension.
  
  
  METHODS
  Eighteen patients (12 men, six women; mean age 49 years [range, 34-68 years]) with CTO-PVT with symptomatic portal hypertension undergoing BA-TIPS between July 2011 and June 2014 were enrolled in this retrospective study. Rates of technical success, efficacy, and complications were evaluated, and pre- and post-procedure portosystemic gradients compared. Clinical follow-up and periodic assessment of TIPS for patency were performed.
  
  
  RESULTS
  BA-TIPS was successful in fourteen patients and converted to open portosystemic shunt placement in four. Mean portosystemic pressure gradient fell from 24.1 ± 2.3 mmHg to 12.1 ± 3.5 mmHg after BA-TIPS (P < 0.01). No procedure-related complications were observed. During a median follow up of 16 months (range, 3-41 months), there was one death from hepatocellular carcinoma, one death from severe heart disease, and shunt dysfunction 16 months after BA-TIPS in one patient. Shunt patency was maintained in the remaining patients without symptoms of recurrence.
  
  
  CONCLUSIONS
  BA-TIPS is feasible, safe, and effective for CTO-PVT with symptomatic portal hypertension.
  
  
  CONCLUSIONS
  • Transjugular intrahepatic portosystemic shunt is an important treatment for portal vein thrombosis (PVT). • TIPS is challenging for patients with chronic totally occluded portal vein thrombosis (CTO-PVT). • The use of a balloon increased the technical success of portal puncture. • Balloon-assisted TIPS (BA-TIPS) is feasible, safe, and effective for CTO-PVT.
authors.affiliation: Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, 1838, North Guangzhou Avenue, Guangzhou City, Guangdong Province, China. cheny102@163.com.
authors.forename: Yong
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, 1838, North Guangzhou Avenue, Guangzhou City, Guangdong Province, China. thomas19871223@163.com.
authors.forename: Peng
authors.initials: P
authors.lastname: Ye
authors.affiliation: Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, 1838, North Guangzhou Avenue, Guangzhou City, Guangdong Province, China. cjr.liyanhao@vip.163.com.
authors.forename: Yanhao
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, 1838, North Guangzhou Avenue, Guangzhou City, Guangdong Province, China. mazelong123456789@126.com.
authors.forename: Shuoyi
authors.initials: S
authors.lastname: Ma
authors.affiliation: Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, 1838, North Guangzhou Avenue, Guangzhou City, Guangdong Province, China. zhaojianbohgl@163.com.
authors.forename: Jianbo
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, 1838, North Guangzhou Avenue, Guangzhou City, Guangdong Province, China. doctorzengqingle@126.com.
authors.forename: Qingle
authors.initials: Q
authors.lastname: Zeng
mesh_terms: D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications* / Q000601:surgery / Q000628:therapy*
keywords: Balloon; Hypertension, portal; Portal vein, cavernous transformation of; Portosystemic shunt, transjugular intrahepatic; Thrombosis