Percutaneous transhepatic intrahepatic portosystemic shunt for variceal bleeding with chronic portal vein occlusion after splenectomy
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The purpose of this study was to introduce a modified transjugular intrahepatic portosystemic shunt (TIPS), a percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS), and to evaluate its feasibility and efficacy in patients with variceal bleeding with chronic portal vein occlusion (CPVO) after splenectomy.
Twenty-four cirrhotic patients with CPVO after splenectomy who received PTIPS between 2010 and 2015 were included in this retrospective study. The indication was elective control of variceal bleeding. Success rates, effectiveness and complications were evaluated, with comparison of the pre- and post-portosystemic pressure gradient (PPG). Patients’ clinical outcomes and shunt patency were followed periodically.
PTIPS was successfully placed in 22 patients (91.7%) and failed in two. The mean PPG fell from 22.0 ± 4.9 mmHg to 10.6 ± 1.6 mmHg after successful PTIPS (p < 0.05). No fatal procedural complications occurred. During the median follow-up of 29 months, shunt dysfunction occurred in five cases and hepatic encephalopathy in four cases. Three patients died because of rebleeding, hepatic failure and pulmonary disease, respectively. The other patients remained asymptomatic and the shunts patent.
We conclude that PTIPS, as a modified TIPS procedure with a high success rate, is safe and effective for variceal bleeding with CPVO after splenectomy.
• Portal vein occlusion used to be contraindication to transjugular intrahepatic portosystemic shunt.
• Portal vein thrombosis is common in patients with previous splenectomy.
• We developed a new method, percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS).
• PTIPS is feasible in patients with portal vein thrombosis and splenectomy.
• PTIPS is effective and safe for these kind of complicated portal hypertension.
KeywordsHypertension, portal Portosystemic shunt, transjugular intrahepatic Thrombosis Varices Splenectomy
Chronic portal vein occlusion
Portosystemic pressure gradient
Percutaneous transhepatic intrahepatic portosystemic shunt
Portal vein thrombosis
This study has received funding from the Science and Technology Planning Project of Guangdong Province, China, No. 2012B031800085.
Compliance with ethical standards
The scientific guarantor of this publication is Zaibo Jiang.
Conflict of interest
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.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional review board approval was obtained.
Study subjects or cohorts overlap
Some study subjects (including one overlap patient) were previously reported by Li MA et al. (Zhonghua Yi Xue Za Zhi 92:2913-2917, 2012).
• performed at one institution
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