title: Outcomes of transjugular intrahepatic portosystemic shunt creation for flow-enabled dissolution of spleno-mesenterico-portal venous thrombosis.
abstract: OBJECTIVE
  To evaluate the outcomes of transjugular intrahepatic portosystemic shunt (TIPS) for flow-enabled clearance of portal (PVT), splenic (SVT) and/or superior mesenteric (MVT) vein thrombosis.
  
  
  METHODS
  In this single-center study, 12 patients underwent TIPS using Viatorr covered stent-grafts (W.L. Gore & Associates, Flagstaff, AZ, USA) from 2008-2014 for PVT as a primary (n=8) or secondary (n=4) indication. TIPS were not accompanied by pharmacomechanical clot disruption; rather, shunts served to increase portal blood flow to allow flow-mediated physiologic clot dissolution. Pre- and post-TIPS cross-sectional imaging were used to assess clot location, size, and clearance, defined by resolution (vessel patency with no clot), reduction (decrease in clot size), stability (no change in clot size), or extension (increase in clot size).
  
  
  RESULTS
  The cohort included 5 men and 7 women (median age 63 years, range 45-73 years, median MELD score 15) with 30 non-occlusive and asymptomatic thrombi spanning main or intrahepatic PVT (n=15/30, 50%), SVT (n=6/30, 20%), and MVT (n=9/30, 30%). TIPS were generally created with 10mm covered stent-grafts; mean final portosystemic pressure gradient was 8mmHg. At mean 190 days post-TIPS, 58% (n=7/12) had clot resolution, 33% (n=4/12) had clot reduction, and 8% (n=1/12) had stable clot; there were no cases of clot extension. Resolution rate was 67% for PVT (10/15), SVT (4/6), and MVT (6/9). Two of 12 (17%) patients underwent successful liver transplant post-TIPS.
  
  
  CONCLUSIONS
  TIPS prompts dissolution of or decrease in PVT, SVT, and MVT in cirrhotic patients. This may be a useful approach notwithstanding omission of pharmacomechanical methods.
authors.affiliation: University of Illinois College of Medicine, University of Illinois Hospital & Health Sciences System, 1740 West Taylor Street, MC 931, Chicago, IL 60612, USA.
authors.forename: J
authors.initials: J
authors.lastname: Lakhoo
authors.affiliation: Department of Radiology, Division of Interventional Radiology, University of Illinois Hospital & Health Sciences System, 1740 West Taylor Street, MC 931, Chicago, IL 60612, USA. Electronic address: rgaba@uic.edu.
authors.forename: R C
authors.initials: RC
authors.lastname: Gaba
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008642:Mesenteric Veins; D008875:Middle Aged; D010690:Phlebography; D011169:Portal Vein; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D012189:Retrospective Studies; D013162:Splenic Vein; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*
keywords: Cirrhosis; Mesenteric venous thrombosis; Portal vein thrombosis (PVT); Transjugular intrahepatic portosystemic shunt (TIPS)