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Safety and Efficacy of Transjugular Intrahepatic Portosystemic Shunt for Non-tumoral Cirrhotic Portal Vein Thrombosis Not Responding to Anticoagulation Therapy

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Abstract

Objectives

To evaluate the feasibility, safety, and efficacy of add-on transjugular–intrahepatic–portosystemic shunt (TIPS) for portal vein recanalization (PVR) in cirrhotic patients with non-tumoral chronic portal vein thrombosis (PVT) after 6 months of monitored anticoagulation therapy (ACT).

Methods

We conducted a retrospective search of the hospital database for patients who underwent TIPS for persistent PVT despite 6 months of ACT (January 2011 to August 2021). These patients were compared to control group (ACT group; no TIPS but continued on ACT). Post-TIPS periodic assessment was done to look for clinical outcome, PVR (using contrast-enhanced CT scan), and complications.

Results

A total of 90 patients were analyzed. Thirty-six patients in TIPS group and 54 patients in ACT group. TIPS was successfully performed in all patients. TIPS group showed complete recanalization of portal vein in 77.8%, partial recanalization in 16.7%, and stable thrombus in 5.5% of the patients. TIPS thrombosis was seen in 3 patients, all underwent successful endovascular thrombolysis. Seven patients developed post-TIPS hepatic encephalopathy and were managed conservatively. In contrast, no patient in ACT group achieved PVR on 12-month follow-up. After propensity score matching, patients in TIPS group showed significantly lower incidence of variceal re-bleeding (22.2% vs. 77.8%, p = 0.03) and refractory ascites (11.1% vs. 51.9%, p < 0.01) with significantly better 12-month survival as compared to ACT group (88.9% vs. 69.4%, p = 0.04).

Conclusion

TIPS in cirrhotic patients with PVT result in superior recanalization rates, better control of ascites, and variceal re-bleeding resulting in better survival. TIPS may be considered a preferred therapy after anticoagulation failure.

Clinical Impact

TIPS is associated with good technical and clinical success in patients of cirrhosis with PVT and should be considered in patients not responding to ACT.

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110070, India

    Amar Mukund, Uday Kumar Marri & Yashwant Patidar

  2. Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110070, India

    Ankur Jindal, Ashok Choudhury & Shiv Kumar Sarin

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  1. Amar Mukund
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  2. Uday Kumar Marri
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Contributions

AM contributed to conceptualization, methodology, reviewing, editing, and finalizing the manuscript. UKM contributed to data curation, data analysis, and preparation of 1st draft of the manuscript. AJ contributed to Patient enrolling, clinical management and methodology, data analysis, and finalizing the manuscript. AC contributed to patient enrolling, clinical management, and data analysis. YP contributed to imaging evaluation of patients and reviewing the manuscript. SKS contributed to supervising the research and reviewing and editing to reach the final version of manuscript.

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Correspondence to Ankur Jindal.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and/or the National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Approval for the study was obtained from Institutional Review Board. IRB approval number: IEC/2022/93/MA18.

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Mukund, A., Marri, U.K., Jindal, A. et al. Safety and Efficacy of Transjugular Intrahepatic Portosystemic Shunt for Non-tumoral Cirrhotic Portal Vein Thrombosis Not Responding to Anticoagulation Therapy. Dig Dis Sci 68, 3174–3184 (2023). https://doi.org/10.1007/s10620-023-07930-4

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