Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110070, India.
Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110070, India.
Dig Dis Sci. 2023 Jul;68(7):3174-3184. doi: 10.1007/s10620-023-07930-4. Epub 2023 May 12.
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).
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.
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).
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.
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.
评估经颈静脉肝内门体分流术（TIPS）在接受抗凝治疗（ACT） 6 个月后仍有非肿瘤性慢性门静脉血栓形成（PVT）的肝硬化患者中进行门静脉再通（PVR）的可行性、安全性和疗效。
我们对医院数据库进行了回顾性检索，以寻找接受 TIPS 治疗但仍存在持续性 PVT 的患者（2011 年 1 月至 2021 年 8 月）。将这些患者与对照组（ACT 组；未进行 TIPS 但继续接受 ACT）进行比较。在 TIPS 后进行定期评估，以观察临床结局、PVR（使用增强 CT 扫描）和并发症。
共分析了 90 例患者。TIPS 组 36 例，ACT 组 54 例。所有患者均成功进行了 TIPS。TIPS 组门静脉完全再通率为 77.8%，部分再通率为 16.7%，稳定血栓率为 5.5%。3 例患者出现 TIPS 血栓，均成功进行了血管内溶栓治疗。7 例患者发生 TIPS 后肝性脑病，均保守治疗。相比之下，ACT 组在 12 个月随访时没有患者实现 PVR。经过倾向评分匹配后，TIPS 组患者的静脉曲张再出血发生率（22.2% vs. 77.8%，p=0.03）和难治性腹水发生率（11.1% vs. 51.9%，p<0.01）明显低于 ACT 组，12 个月生存率也明显高于 ACT 组（88.9% vs. 69.4%，p=0.04）。
在 PVT 的肝硬化患者中，TIPS 可实现更高的再通率，更好地控制腹水和静脉曲张再出血，从而提高生存率。TIPS 可能是抗凝治疗失败后的首选治疗方法。
TIPS 在接受 ACT 治疗的 PVT 肝硬化患者中具有良好的技术和临床成功率，对于对抗凝治疗无反应的患者应考虑使用。
