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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

  • Interventional
  • Published:
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Abstract

Objectives

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.

Key Points

• 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.

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Abbreviations

BA-TIPS:

Balloon-assisted transjugular intrahepatic portosystemic shunt

CTO-PVT:

Chronic totally occluded portal vein thrombosis

MPV:

Main portal vein

PV:

Portal vein

SMV:

Superior mesenteric vein

SV:

Splenic vein

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Acknowledgments

The scientific guarantor of this publication is Yong Chen. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding from the Science and Technology Planning Project of Guangdong Province (2012B010200027) and the Key Technologies R&D Program of Guangzhou (201300000199). No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects were previously reported by Stephen Chen (J Vasc Interv Radiol 14: 513-514) and N. Jourabchi et al. (Case Rep Radiol 2013: 635391). Methodology: retrospective, performed at one institution.

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Authors and Affiliations

  1. Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, 1838, North Guangzhou Avenue, Guangzhou City, Guangdong Province, China

    Yong Chen, Peng Ye, Yanhao Li, Shuoyi Ma, Jianbo Zhao & Qingle Zeng

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  1. Yong Chen
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  2. Peng Ye
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  3. Yanhao Li
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  4. Shuoyi Ma
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  5. Jianbo Zhao
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Correspondence to Yong Chen.

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Chen, Y., Ye, P., Li, Y. et al. 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. Eur Radiol 25, 3431–3437 (2015). https://doi.org/10.1007/s00330-015-3777-1

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  • DOI: https://doi.org/10.1007/s00330-015-3777-1

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