title: Portal Vein Recanalization and Transjugular Intrahepatic Portosystemic Shunt Creation for Chronic Portal Vein Thrombosis: Technical Considerations.
abstract: Portal vein thrombosis (PVT) is common in cirrhotic patients and presents a challenge at the time of transplant. Owing to the increased posttransplant morbidity and mortality associated with complete PVT, the presence of PVT is a relative contraindication to liver transplantation at many centers. Our group began performing portal vein (PV) recanalization and transjugular intrahepatic portostystemic shunt placement (PVR-TIPS) several years ago to optimize the transplant candidacy of patients with PVT. The procedure has evolved to include transsplenic access to assist with recanalization, which is now our preferred method due to its technical success without significant added morbidity. Here, we describe in detail our approach to PVR-TIPS with a focus on the transsplenic method. The procedure was attempted in 61 patients and was technically successful in 60 patients (98%). After transitioning to transsplenic access to assist with recanalization, the technical success rate has improved to 100%. The recanalized portal vein and TIPS have maintained patency during follow-up, or to the time of transplant, in 55 patients (92%) with a mean follow-up of 16.7 months. In total, 23 patients (38%) have undergone transplant, all of whom received a physiologic anastomosis (end-to-end anastomosis in 22 of 23 patients, 96%). PVR-TIPS placement should be considered as an option for patients with chronic PVT in need of transplantation. Transsplenic access makes the procedure technically straightforward and should be considered as the primary method for recanalization.
authors.affiliation: Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL.
authors.forename: Bartley
authors.initials: B
authors.lastname: Thornburg
authors.affiliation: Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL.
authors.forename: Kush
authors.initials: K
authors.lastname: Desai
authors.affiliation: Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL.
authors.forename: Ryan
authors.initials: R
authors.lastname: Hickey
authors.affiliation: Department of Medicine, Northwestern University, Chicago, IL.
authors.forename: Laura
authors.initials: L
authors.lastname: Kulik
authors.affiliation: Department of Medicine, Northwestern University, Chicago, IL.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ganger
authors.affiliation: Department of Surgery, Comprehensive Transplant Center, Northwestern University, Chicago, IL.
authors.forename: Talia
authors.initials: T
authors.lastname: Baker
authors.affiliation: Department of Surgery, Comprehensive Transplant Center, Northwestern University, Chicago, IL.
authors.forename: Michael
authors.initials: M
authors.lastname: Abecassis
authors.affiliation: Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
authors.affiliation: Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL; Department of Surgery, Comprehensive Transplant Center, Northwestern University, Chicago, IL; Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL. Electronic address: r-salem@northwestern.edu.
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
mesh_terms: D000368:Aged; D002908:Chronic Disease; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D018810:Magnetic Resonance Angiography; D008297:Male; D010690:Phlebography; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects; D011172:Portography; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*
keywords: Portal vein thrombosis; TIPS; liver transplantation