Skip to main content
SpringerLink
Log in

Transjugular Intrahepatic Portosystemic Shunt for Non-malignant Portal Vein Thrombosis

  • Chapter
  • First Online:
Portal Vein Thrombosis

  • 554 Accesses

Abstract

Portal vein thrombosis (PVT) is characterised by the presence of thrombus in the main portal vein, with or without intra-hepatic or mesenteric extension. PVT can arise in a non-cirrhotic liver, or on a background of cirrhosis. The etiologies, natural history, prognosis and therapeutic implications differ in both groups accordingly. Currently, anticoagulation is primarily recommended for those with acute PVT but is fraught with a theoretical risk of bleeding. Surgical therapy in these patients might be over-aggressive. In the past, transjugular intrahepatic portosystemic shunt (TIPS) placement was considered a relative contraindication in patients with PVT but now has been shown to be safe and efficacious in these patients, both with and without cirrhosis, with some caveats and modifications. What remains to be explored is the stage at which TIPS should be offered and whether it should be preferred over therapeutic anticoagulation. Randomized controlled trials are needed to answer this question.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Intagliata NM, Caldwell SH, Tripodi A. Diagnosis, development, and treatment of portal vein thrombosis in patients with and without cirrhosis. Gastroenterology. 2019;156(6):1582-1599.e1.

    Article  Google Scholar 

  2. Walser EM, NcNees SW, DeLa Pena O, Crow WN, Morgan RA, Soloway R, et al. Portal venous thrombosis: percutaneous therapy and outcome. J Vasc Interv Radiol. 1998;9(1 Pt 1):119–27.

    Article  CAS  Google Scholar 

  3. Senzolo M, Tibbals J, Cholongitas E, Triantos CK, Burroughs AK, Patch D. Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with and without cavernous transformation. Aliment Pharmacol Ther. 2006;23(6):767–75.

    Article  CAS  Google Scholar 

  4. Valentin N, Korrapati P, Constantino J, Young A, Weisberg I. The role of transjugular intrahepatic portosystemic shunt in the management of portal vein thrombosis: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2018;30(10):1187–93.

    Article  Google Scholar 

  5. Rodrigues SG, Sixt S, Abraldes JG, De Gottardi A, Klinger C, Bosch J, et al. Systematic review with meta-analysis: portal vein recanalisation and transjugular intrahepatic portosystemic shunt for portal vein thrombosis. Aliment Pharmacol Ther. 2019;49(1):20–30.

    Article  Google Scholar 

  6. Ageno W, Dentali F, Pomero F, Fenoglio L, Squizzato A, Pagani G, et al. Incidence rates and case fatality rates of portal vein thrombosis and Budd-Chiari Syndrome. Thromb Haemost. 2017;117(4):794–800.

    Article  Google Scholar 

  7. Ogren M, Bergqvist D, Björck M, Acosta S, Eriksson H, Sternby NH. Portal vein thrombosis: prevalence, patient characteristics and lifetime risk: a population study based on 23,796 consecutive autopsies. World J Gastroenterol. 2006;12(13):2115–9.

    Article  Google Scholar 

  8. Rodríguez-Castro KI, Porte RJ, Nadal E, Germani G, Burra P, Senzolo M. Management of nonneoplastic portal vein thrombosis in the setting of liver transplantation: a systematic review. Transplantation. 2012;94(11):1145–53.

    Article  Google Scholar 

  9. Amitrano L, Guardascione MA, Brancaccio V, Margaglione M, Manguso F, Iannaccone L, et al. Risk factors and clinical presentation of portal vein thrombosis in patients with liver cirrhosis. J Hepatol. 2004;40(5):736–41.

    Article  Google Scholar 

  10. Belli L, Romani F, Sansalone CV, Aseni P, Rondinara G. Portal thrombosis in cirrhotics. A retrospective analysis. Ann Surg. 1986;203(3):286–91.

    Article  CAS  Google Scholar 

  11. Francoz C, Belghiti J, Vilgrain V, Sommacale D, Paradis V, Condat B, et al. Splanchnic vein thrombosis in candidates for liver transplantation: usefulness of screening and anticoagulation. Gut. 2005;54(5):691–7.

    Article  CAS  Google Scholar 

  12. Amitrano L, Guardascione MA, Scaglione M, Pezzullo L, Sangiuliano N, Armellino MF, et al. Prognostic factors in noncirrhotic patients with splanchnic vein thromboses. Am J Gastroenterol. 2007;102(11):2464–70.

    Article  Google Scholar 

  13. Plessier A, Darwish-Murad S, Hernandez-Guerra M, Consigny Y, Fabris F, Trebicka J, et al. Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study. Hepatology. 2010;51(1):210–8.

    Article  Google Scholar 

  14. Khanna R, Sarin SK. Idiopathic portal hypertension and extrahepatic portal venous obstruction. Hepatol Int. 2018;12(Suppl 1):148–67.

    Article  Google Scholar 

  15. Qi X, Guo X, Yoshida EM, Méndez-Sánchez N, De Stefano V, Tacke F, et al. Transient portal vein thrombosis in liver cirrhosis. BMC Med. 2018;16(1):83.

    Article  Google Scholar 

  16. Chen H, Turon F, Hernández-Gea V, Fuster J, Garcia-Criado A, Barrufet M, et al. Nontumoral portal vein thrombosis in patients awaiting liver transplantation. Liver Transpl. 2016;22(3):352–65.

    Article  Google Scholar 

  17. De Gaetano AM, Lafortune M, Patriquin H, De Franco A, Aubin B, Paradis K. Cavernous transformation of the portal vein: patterns of intrahepatic and splanchnic collateral circulation detected with Doppler sonography. AJR Am J Roentgenol. 1995;165(5):1151–5.

    Article  Google Scholar 

  18. Sherman CB, Behr S, Dodge JL, Roberts JP, Yao FY, Mehta N. Distinguishing tumor from bland portal vein thrombus in liver transplant candidates with hepatocellular carcinoma: the A-VENA criteria. Liver Transpl. 2019;25(2):207–16.

    Article  Google Scholar 

  19. Han G, Qi X, He C, Yin Z, Wang J, Xia J, et al. Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with symptomatic portal hypertension in liver cirrhosis. J Hepatol. 2011;54(1):78–88.

    Article  Google Scholar 

  20. European Association for the Study of the Liver. EASL clinical practice guidelines: vascular diseases of the liver. J Hepatol. 2016;64(1):179–202.

    Google Scholar 

  21. Klinger C, Riecken B, Schmidt A, De Gottardi A, Meier B, Bosch J, et al. Transjugular local thrombolysis with/without TIPS in patients with acute non-cirrhotic, non-malignant portal vein thrombosis. Dig Liver Dis. 2017;49(12):1345–52.

    Article  Google Scholar 

  22. Rössle M, Bettinger D, Trebicka J, Klinger C, Praktiknjo M, Sturm L, et al. A prospective, multicentre study in acute noncirrhotic, nonmalignant portal vein thrombosis: comparison of medical and interventional treatment. Aliment Pharmacol Ther. 2020;52:329–39.

    Google Scholar 

  23. de Franchis R, Baveno VI Faculty. Expanding consensus in portal hypertension: report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63(3):743–52.

    Google Scholar 

  24. Pal S. Current role of surgery in portal hypertension. Indian J Surg. 2012;74(1):55–66.

    Article  Google Scholar 

  25. Qi X, Han G, Yin Z, He C, Wang J, Guo W, et al. Transjugular intrahepatic portosystemic shunt for portal cavernoma with symptomatic portal hypertension in non-cirrhotic patients. Dig Dis Sci. 2012;57(4):1072–82.

    Article  Google Scholar 

  26. Fanelli F, Angeloni S, Salvatori FM, Marzano C, Boatta E, Merli M, et al. Transjugular intrahepatic portosystemic shunt with expanded-polytetrafuoroethylene-covered stents in non-cirrhotic patients with portal cavernoma. Dig Liver Dis. 2011;43(1):78–84.

    Article  Google Scholar 

  27. Lv Y, He C, Guo W, Yin Z, Wang J, Zhang B, et al. Transjugular intrahepatic portosystemic shunt for extrahepatic portal venous obstruction in children. J Pediatr Gastroenterol Nutr. 2016;62(2):233–41.

    Article  CAS  Google Scholar 

  28. Hibi T, Nishida S, Levi DM, Selvaggi G, Tekin A, Fan J, et al. When and why portal vein thrombosis matters in liver transplantation: a critical audit of 174 cases. Ann Surg. 2014;259(4):760–6.

    Article  Google Scholar 

  29. DeLeve LD, Valla DC, Garcia-Tsao G, American Association for the Study Liver Diseases. Vascular disorders of the liver. Hepatology. 2009;49(5):1729–64.

    Google Scholar 

  30. Villa E, Cammà C, Marietta M, Luongo M, Critelli R, Colopi S, et al. Enoxaparin prevents portal vein thrombosis and liver decompensation in patients with advanced cirrhosis. Gastroenterology. 2012;143(5):1253–1260.e4.

    Article  Google Scholar 

  31. Delgado MG, Seijo S, Yepes I, Achécar L, Catalina MV, García-Criado A, et al. Efficacy and safety of anticoagulation on patients with cirrhosis and portal vein thrombosis. Clin Gastroenterol Hepatol. 2012;10(7):776–83.

    Article  Google Scholar 

  32. Luca A, Miraglia R, Caruso S, Milazzo M, Sapere C, Maruzzelli L, et al. Short- and long-term effects of the transjugular intrahepatic portosystemic shunt on portal vein thrombosis in patients with cirrhosis. Gut. 2011;60(6):846–52.

    Article  Google Scholar 

  33. Luo X, Wang Z, Tsauo J, Zhou B, Zhang H, Li X. Advanced cirrhosis combined with portal vein thrombosis: a randomized trial of TIPS versus endoscopic band ligation plus propranolol for the prevention of recurrent esophageal variceal bleeding. Radiology. 2015;276(1):286–93.

    Article  Google Scholar 

  34. Lv Y, Qi X, He C, Wang Z, Yin Z, Niu J, et al. Covered TIPS versus endoscopic band ligation plus propranolol for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis: a randomised controlled trial. Gut. 2018;67(12):2156–68.

    Article  CAS  Google Scholar 

  35. Shalimar, Gamanagatti SR, Patel AH, Kedia S, Nayak B, Gunjan D, et al. Long-term outcomes of transjugular intrahepatic portosystemic shunt in Indian patients with Budd-Chiari syndrome. Eur J Gastroenterol Hepatol. 2017;29(10):1174–82.

    Article  CAS  Google Scholar 

  36. Sharma S, Kumar R, Rout G, Gamanagatti SR. Shalimar. Dabigatran as an oral anticoagulant in patients with Budd–Chiari syndrome post-percutaneous endovascular intervention. J Gastroenterol Hepatol. 2020;35(4):654–62.

    Article  CAS  Google Scholar 

  37. Priyanka P, Kupec JT, Krafft M, Shah NA, Reynolds GJ. Newer oral anticoagulants in the treatment of acute portal vein thrombosis in patients with and without cirrhosis. Int J Hepatol. 2018;2018:8432781.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India

    Anshuman Elhence &  Shalimar

  2. Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India

    Shivanand Ramachandra Gamanagatti

Authors
  1. Anshuman Elhence
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shivanand Ramachandra Gamanagatti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shalimar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shalimar .

Editor information

Editors and Affiliations

  1. Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China

    Xingshun Qi

  2. Department of Gastroenterology, Changzheng Hospital, Second Military Medical University, Shanghai, China

    Weifen Xie

Rights and permissions

Reprints and permissions

Copyright information

© 2021 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Elhence, A., Gamanagatti, S.R., Shalimar (2021). Transjugular Intrahepatic Portosystemic Shunt for Non-malignant Portal Vein Thrombosis. In: Qi, X., Xie, W. (eds) Portal Vein Thrombosis. Springer, Singapore. https://doi.org/10.1007/978-981-33-6538-4_9

Download citation

  • DOI: https://doi.org/10.1007/978-981-33-6538-4_9

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-33-6537-7

  • Online ISBN: 978-981-33-6538-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation