Ali Habib1, Kush Desai1, Ryan Hickey1, Bartley Thornburg1, Michael Vouche1, Robert L Vogelzang1, Riad Salem2. 1. Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611. 2. Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611.. Electronic address: r-salem@northwestern.edu.
Abstract
PURPOSE: To present the transsplenic route as an alternative approach for portal vein recanalization-transjugular portosystemic shunt (PVR-TIPS) for chronic main portal vein thrombosis (PVT) in potential transplant candidates. MATERIALS AND METHODS: In 2013-2014, 11 consecutive patients with cirrhosis-induced chronic main PVT underwent transsplenic PVR-TIPS. All patients had been denied listing for transplant because of the presence of main PVT, a relative contraindication in this center. The patients were followed for adverse events. Portal vein patency was assessed at 1 month by splenoportography and every 3 months subsequently by ultrasound or magnetic resonance imaging. After PVR-TIPS, patients were reviewed (and subsequently listed for transplant) at a weekly multidisciplinary conference. RESULTS: PVR-TIPS using the transsplenic approach was successful in all 11 patients with no major complications. Median age was 61 years (range, 33-67 y) and 9 of 11 patients (82%) were men. Nonalcoholic steatohepatitis was the leading cause of liver disease in 4 of 11 patients (36%), and hepatitis C was present in 4 of 11 patients (36%). Complete main PVT was found in 8 of 11 patients (73%). Of 11 patients, 4 (36%) had a Model for End-Stage Liver Disease score > 18, and 8 (73%) had a baseline Child-Pugh score of 7-10. Minor adverse events occurred in 2 of 11 patients (fever, encephalopathy). At the end of the procedure, 5 of 11 patients (45%) exhibited some minor remaining thrombus in the portal vein; 3 of the 5 patients (60%) had complete thrombus resolution at 1 month, with the remaining 2 patients having resolution at 3 months (no anticoagulation was needed). Three patients underwent successful liver transplant with end-to-end anastomoses. CONCLUSIONS: Transsplenic PVR-TIPS is a potentially safe and effective method to treat PVT and improve transplant candidacy.
PURPOSE: To present the transsplenic route as an alternative approach for portal vein recanalization-transjugular portosystemic shunt (PVR-TIPS) for chronic main portal vein thrombosis (PVT) in potential transplant candidates. MATERIALS AND METHODS: In 2013-2014, 11 consecutive patients with cirrhosis-induced chronic main PVT underwent transsplenic PVR-TIPS. All patients had been denied listing for transplant because of the presence of main PVT, a relative contraindication in this center. The patients were followed for adverse events. Portal vein patency was assessed at 1 month by splenoportography and every 3 months subsequently by ultrasound or magnetic resonance imaging. After PVR-TIPS, patients were reviewed (and subsequently listed for transplant) at a weekly multidisciplinary conference. RESULTS: PVR-TIPS using the transsplenic approach was successful in all 11 patients with no major complications. Median age was 61 years (range, 33-67 y) and 9 of 11 patients (82%) were men. Nonalcoholic steatohepatitis was the leading cause of liver disease in 4 of 11 patients (36%), and hepatitis C was present in 4 of 11 patients (36%). Complete main PVT was found in 8 of 11 patients (73%). Of 11 patients, 4 (36%) had a Model for End-Stage Liver Disease score > 18, and 8 (73%) had a baseline Child-Pugh score of 7-10. Minor adverse events occurred in 2 of 11 patients (fever, encephalopathy). At the end of the procedure, 5 of 11 patients (45%) exhibited some minor remaining thrombus in the portal vein; 3 of the 5 patients (60%) had complete thrombus resolution at 1 month, with the remaining 2 patients having resolution at 3 months (no anticoagulation was needed). Three patients underwent successful liver transplant with end-to-end anastomoses. CONCLUSIONS: Transsplenic PVR-TIPS is a potentially safe and effective method to treat PVT and improve transplant candidacy.
Authors: A Dogar; K Ullah; Sh Uddin; Y Memon; M Zafar; H Bilal; A Shoaib; A Ghaffar; S Hasnain; Q Soomro Journal: Int J Organ Transplant Med Date: 2021
Authors: Jason T Salsamendi; Francisco J Gortes; Michelle Shnayder; Mehul H Doshi; Ji Fan; Govindarajan Narayanan Journal: Radiol Case Rep Date: 2016-06-21
Authors: Dmitri Bezinover; Khaled Iskandarani; Vernon Chinchilli; Patrick McQuillan; Fuat Saner; Zakiyah Kadry; Thomas R Riley; Piotr K Janicki Journal: BMC Anesthesiol Date: 2016-05-21 Impact factor: 2.217