Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Treatment of Venous Symptomatic Chronic Portal Thrombosis in Non-cirrhotic Patients

Journal Article · Wed Sep 15 04:00:00 EDT 2004 · Cardiovascular and Interventional Radiology

DOI:https://doi.org/10.1007/S00270-004-0241-Z· OSTI ID:21088214

Elorz, Mariana; Vivas, Isabel; Martinez-Cuesta, Antonio; Bastarrika, Gorka; Benito, Alberto ^[1]

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1. Universidad de Navarra, Department of Radiology, Clinica Universitaria, Facultad de Medicina (Spain)

Purpose: To present a series of cases of non-cirrhotic patients with symptomatic massive portal thrombosis treated by percutaneous techniques. All patients underwent a TIPS procedure in order to maintain the patency of the portal vein by facilitating the outflow. Methods: A total of six patients were treated for thrombosis of the main portal vein (6/6); the main right and left branches (3/6) and the splenic vein (5/6) and superior mesenteric vein (6/6). Two patients had a pancreatic malignancy; one patient with an orthotopic liver transplant had been surgically treated for a pancreatic carcinoma. Two patients had idiopathic thrombocytosis, and in the remaining patient no cause for the portal thrombosis was identified. During the initial procedure in each patient one or more approaches were tried: transhepatic (5/6), transileocolic (1/6), trans-splenic (1/6) or transjugular (1/6). In all cases the procedure was completed with a TIPS with either ultrasound guidance (3/6), 'gun-shot' technique (2/6) or fluoroscopic guidance (1/6).Results: No complications were observed during the procedures. One patient had a repeat episode of variceal bleeding at 30 months, one patient remained asymptomatic and was lost to follow-up at 24 months, two patients were successfully treated surgically (cephalic duodenopancreatectomy) and are alive at 4 and 36 months. One patient remains asymptomatic (without new episodes of abdominal pain) at 16 months of follow-up. One patient died because of tumor progression at 10 months. Conclusion: Percutaneous techniques for portal recanalization are an interesting alternative even in non-acute thrombosis. Once flow has been restored in the portal vein TIPS may be necessary to obtain an adequate outflow, hence facilitating and maintaining the portal flow.

• OSTI ID: 21088214
• Journal Information: Cardiovascular and Interventional Radiology, Journal Name: Cardiovascular and Interventional Radiology Journal Issue: 5 Vol. 27; ISSN 0174-1551; ISSN CAIRDG
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BYPASSES
CARCINOMAS
LIVER
PAIN
PANCREAS
PATIENTS
THROMBOSIS
TRANSPLANTS
VEINS