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Retrograde transvenous obliteration for the prevention of variceal rebleeding in patients with portal vein thrombosis: a multicenter study

  • Vascular-Interventional
  • Published:
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Abstract

Objectives

To evaluate the effectiveness of retrograde transvenous obliteration (RTO) for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis (PVT).

Methods

Consecutive cirrhotic patients with PVT who underwent RTO for the prevention of variceal rebleeding between January 2002 and June 2019 were included in this multicenter retrospective study. The primary outcome measure was rebleeding. The secondary outcome measures were survival, other complications of portal hypertension, liver function, and PVT.

Results

Forty-five patients (mean age, 66.0 ± 10.6 years; mean Model for End-Stage Liver Disease (MELD) score, 13.9 ± 5.5) were included. The 1-year actuarial probability of remaining free of rebleeding was 92.8 ± 4.0%. The 6-week, 1-year, and 3-year actuarial probabilities of survival were 79.8 ± 6.0%, 48.8 ± 7.7%, and 46.1 ± 7.9%, respectively. MELD score (hazard ratio (HR), 1.09 (95% confidence interval (CI), 1.01–1.17); p = .013) and ascites (HR, 2.84 (95% CI, 1.24–6.55); p = .014) were identified as significant predictors of survival. The 1-year actuarial probabilities of remaining free of new or worsening ascites and esophageal varices were 81.2 ± 8.7% and 89.2 ± 6.0%, respectively. No patients had overt hepatic encephalopathy during follow-up. MELD score significantly increased by a mean of 3.8 (95% CI, 1.7–6.0) at 3 months (p = .001). PVT had improved in 32.0%, worsened in 12.0%, and remained unchanged in 56.0% of patients at 3 months.

Conclusion

RTO may be effective for the prevention of variceal rebleeding in cirrhotic patients with PVT.

Key Points

• Retrograde transvenous obliteration may prevent variceal rebleeding in cirrhotic patients with portal vein thrombosis.

• The risks of other complications of portal hypertension may not be high after retrograde transvenous obliteration in cirrhotic patients with portal vein thrombosis.

• Portal vein thrombosis may improve in approximately one-third of cirrhotic patients within 3 months after retrograde transvenous obliteration.

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Abbreviations

BRTO:

Balloon-occluded RTO

CARTO:

Coil-assisted RTO

CI:

Confidence interval

EASL:

European Association for the Study of the Liver

HR:

Hazard ratio

HE:

Hepatic encephalopathy

HRS:

Hepatorenal syndrome

LT:

Liver transplantation

MELD:

Model for End-Stage Liver Disease

NSBB:

Non-selective beta-blockers

PARTO:

Plug-assisted RTO

PVT:

Portal vein thrombosis

RTO:

Retrograde transvenous obliteration

TIPS:

Transjugular intrahepatic portosystemic shunt

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Author notes

  1. Jiaywei Tsauo and Seung Yeon Noh contributed equally to this work.

Authors and Affiliations

  1. Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China

    Jiaywei Tsauo

  2. Department of Radiology, Soon Chun Hyang University Seoul Hospital, Seoul, South Korea

    Seung Yeon Noh

  3. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea

    Ji Hoon Shin & Dong Il Gwon

  4. Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea

    Kichang Han

  5. Department of Radiology, Soon Chun Hyang University Hospital, Bucheon, South Korea

    Jae Myeong Lee

  6. Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, South Korea

    Ung Bae Jeon

  7. Department of Radiology, Daegu Catholic University Medical Center, Daegu, South Korea

    Young Hwan Kim

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  1. Jiaywei Tsauo
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Correspondence to Ji Hoon Shin.

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• case series

• multicenter study

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Tsauo, J., Noh, S.Y., Shin, J.H. et al. Retrograde transvenous obliteration for the prevention of variceal rebleeding in patients with portal vein thrombosis: a multicenter study. Eur Radiol 31, 559–566 (2021). https://doi.org/10.1007/s00330-020-07109-9

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  • DOI: https://doi.org/10.1007/s00330-020-07109-9

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