Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
Institute of Clinical Radiology, University Hospital Muenster, Muenster, Germany.
Abdom Radiol (NY). 2022 Mar;47(3):1177-1186. doi: 10.1007/s00261-022-03411-w. Epub 2022 Jan 12.
To compare the safety and outcome of transjugular versus percutaneous technique in recanalization of non-cirrhotic, non-malignant portal vein thrombosis.
We present a retrospective bicentric analysis of 21 patients with non-cirrhotic, non-malignant PVT, who were treated between 2016 and 2021 by interventional recanalization via different access routes (percutaneous [PT] vs. transjugular in transhepatic portosystemic shunt [TIPS] technique). Complication rates with a focus on periprocedural bleeding and patency as well as outcome were compared.
Of the 21 patients treated (median age 48 years, range of 19-78), seven (33%) patients had an underlying prothrombotic condition. While 14 (57%) patients were treated for acute PVT, seven (43%) patients had progressive thrombosis with known chronic PVT. Nine patients underwent initial recanalization via PT access and twelve via TIPS technique. There was no significant difference in complete technical success rate according to initial access route (55.5% in PT group vs. 83.3% in TIPS group, p = 0.331). However, creation of an actual TIPS was associated with higher technical success in restoring portal venous flow (86.6% vs. 33.3%, p = 0.030). 13 (61.9%) patients received thrombolysis. Nine (42.8%) patients experienced hemorrhagic complications. In a multivariate analysis, thrombolysis (p = 0.049) and PT access as the first procedure (p = 0.045) were significant risk factors for bleeding.
Invasive recanalization of the portal vein in patients with PVT and absence of cirrhosis and malignancy offers a good therapeutic option with high recanalization and patency rates. Bleeding complications result predominantly from a percutaneous access and high amounts of thrombolytics used; therefore, recanalization via TIPS technique should be favored.
比较经颈静脉与经皮技术在非肝硬化、非恶性门静脉血栓再通中的安全性和结果。
我们对 2016 年至 2021 年间通过不同入路（经皮[PT]与经肝门体分流术[TIPS]技术中的经颈静脉）进行介入再通治疗的 21 例非肝硬化、非恶性 PVT 患者进行回顾性分析。比较并发症发生率，重点关注围手术期出血和通畅率以及结果。
21 例患者（中位年龄 48 岁，范围 19-78 岁）中，有 7 例（33%）存在潜在的血栓形成情况。14 例（57%）患者因急性 PVT 接受治疗，7 例（43%）患者因已知的慢性 PVT 而进展性血栓形成。9 例患者最初经 PT 入路进行再通，12 例患者经 TIPS 技术进行再通。根据初始入路，完全技术成功率无显著差异（PT 组为 55.5%，TIPS 组为 83.3%，p=0.331）。然而，实际创建 TIPS 与恢复门静脉血流的更高技术成功率相关（86.6%比 33.3%，p=0.030）。13 例（61.9%）患者接受溶栓治疗。9 例（42.8%）患者发生出血性并发症。在多变量分析中，溶栓治疗（p=0.049）和经皮入路作为第一程序（p=0.045）是出血的显著危险因素。
在不存在肝硬化和恶性肿瘤的 PVT 患者中，对门静脉进行有创再通是一种很好的治疗选择，具有较高的再通和通畅率。出血并发症主要由经皮入路和使用大量溶栓药物引起；因此，应优先选择 TIPS 技术进行再通。
