Saraswat Vrishit, Singhal Soumil, Khandelwal Anubhav Harish, Mehndiratta Anurag, Jha Sonalika, Khandelwal Rohit, Kapoor Abhay, Singh Girendra Shankar, Reddy Raghuveer, Ram Heera, Baijal Sanjay Saran
Medanta-The Medicity, India.
Narayana Health, Jaipur, India.
Interv Radiol (Higashimatsuyama). 2025 Sep 3;10:e20240041. doi: 10.22575/interventionalradiology.2024-0041. eCollection 2025.
Portal vein thrombosis (PVT), is seen in about 25% of patients with cirrhosis. Chronic portal vein thrombosis can significantly alter anatomy, often leading to the diversion of splanchnic blood into expansive and compliant vascular channels. This process generates extensive collateral networks and large varices that function as portosystemic shunts. Portal cavernous transformation represents a critical vascular condition marked by the formation of a network of collateral veins that develops to bypass an obstructed portal vein [PV]. Given these physiological changes, performing liver transplantation is associated with higher morbidity and mortality rates. We present an early, single-center experience for portal vein reconstruction (PVR) and the creation of a transjugular intrahepatic portosystemic shunt (TIPS) to increase transplant candidacy in such patients. Retrospectively, data was obtained from the Picture Archiving and Communication System (PACS) and Hospital Information System (HIS) from a single center between January 2016 to January 2024. In total, 15 patients with obliterative main portal vein thrombosis were selected. These patients underwent Percutaneous transhepatic portal vein recanalization with transjugular intrahepatic portosystemic shunt to increase their transplant eligibility after a collaborative imaging examination by transplant surgery and interventional radiology team. Up until liver transplant LT, patients were monitored in the hepatology/transplant clinic, and thereafter in the posttransplant clinic. To confirm portal vein PV patency, serial ultrasound/Dynamic computed tomography/magnetic resonance imaging was done. Portal vein recanalization with transjugular intrahepatic portosystemic shunt was performed in 15 patients. Technical success, defined as the maintenance of patency in both the portal vein and the transjugular intrahepatic portosystemic shunt at the conclusion of the procedure, was achieved in all 15 cases (100%). Patients with portal vein thrombosis may significantly benefit from portal vein recanalization with transjugular intrahepatic portosystemic shunt, enhancing transplantation candidacy and facilitating physiologic end-to-end anastomoses.
门静脉血栓形成（PVT）在约25%的肝硬化患者中可见。慢性门静脉血栓形成可显著改变解剖结构，常导致内脏血液分流至扩张且顺应性良好的血管通道。这一过程会产生广泛的侧支网络和大的静脉曲张，起到门体分流的作用。门静脉海绵样变性是一种严重的血管状况，其特征是形成 collateral veins 网络以绕过阻塞的门静脉[PV]。鉴于这些生理变化，进行肝移植会伴随着更高的发病率和死亡率。我们展示了一项早期的单中心门静脉重建（PVR）及经颈静脉肝内门体分流术（TIPS）创建的经验，以增加此类患者的移植候选资格。回顾性地，从2016年1月至2024年1月期间一个单中心的图像存档与通信系统（PACS）和医院信息系统（HIS）获取数据。总共选取了15例主门静脉闭塞性血栓形成的患者。这些患者在经过移植外科和介入放射学团队的联合影像检查后，接受了经皮经肝门静脉再通术及经颈静脉肝内门体分流术，以增加其移植资格。在肝移植（LT）之前，患者在肝病/移植门诊接受监测，之后在移植后门诊接受监测。为确认门静脉（PV）通畅，进行了系列超声/动态计算机断层扫描/磁共振成像检查。15例患者接受了经颈静脉肝内门体分流术的门静脉再通术。技术成功定义为在手术结束时门静脉和经颈静脉肝内门体分流术均保持通畅，所有15例（100%）均实现了技术成功。门静脉血栓形成的患者可能会从经颈静脉肝内门体分流术的门静脉再通术中显著获益，提高移植候选资格并促进生理性端端吻合。
