Yong Chen1, Peng Ye2, Yanhao Li3, Shuoyi Ma4, Jianbo Zhao5, Qingle Zeng6. 1. Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, 1838, North Guangzhou Avenue, Guangzhou City, Guangdong Province, China. cheny102@163.com. 2. Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, 1838, North Guangzhou Avenue, Guangzhou City, Guangdong Province, China. thomas19871223@163.com. 3. Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, 1838, North Guangzhou Avenue, Guangzhou City, Guangdong Province, China. cjr.liyanhao@vip.163.com. 4. Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, 1838, North Guangzhou Avenue, Guangzhou City, Guangdong Province, China. mazelong123456789@126.com. 5. Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, 1838, North Guangzhou Avenue, Guangzhou City, Guangdong Province, China. zhaojianbohgl@163.com. 6. Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, 1838, North Guangzhou Avenue, Guangzhou City, Guangdong Province, China. doctorzengqingle@126.com.
Abstract
OBJECTIVES: To introduce a modified transjugular intrahepatic portosystemic shunt (TIPS) procedure, percutaneous transhepatic balloon-assisted TIPS (BA-TIPS), and to evaluate its feasibility and efficacy in patients with chronic totally occluded portal vein thrombosis (CTO-PVT) with symptomatic portal hypertension. METHODS: Eighteen patients (12 men, six women; mean age 49 years [range, 34-68 years]) with CTO-PVT with symptomatic portal hypertension undergoing BA-TIPS between July 2011 and June 2014 were enrolled in this retrospective study. Rates of technical success, efficacy, and complications were evaluated, and pre- and post-procedure portosystemic gradients compared. Clinical follow-up and periodic assessment of TIPS for patency were performed. RESULTS: BA-TIPS was successful in fourteen patients and converted to open portosystemic shunt placement in four. Mean portosystemic pressure gradient fell from 24.1 ± 2.3 mmHg to 12.1 ± 3.5 mmHg after BA-TIPS (P < 0.01). No procedure-related complications were observed. During a median follow up of 16 months (range, 3-41 months), there was one death from hepatocellular carcinoma, one death from severe heart disease, and shunt dysfunction 16 months after BA-TIPS in one patient. Shunt patency was maintained in the remaining patients without symptoms of recurrence. CONCLUSIONS: BA-TIPS is feasible, safe, and effective for CTO-PVT with symptomatic portal hypertension. KEY POINTS: • Transjugular intrahepatic portosystemic shunt is an important treatment for portal vein thrombosis (PVT). • TIPS is challenging for patients with chronic totally occluded portal vein thrombosis (CTO-PVT). • The use of a balloon increased the technical success of portal puncture. • Balloon-assisted TIPS (BA-TIPS) is feasible, safe, and effective for CTO-PVT.
OBJECTIVES: To introduce a modified transjugular intrahepatic portosystemic shunt (TIPS) procedure, percutaneous transhepatic balloon-assisted TIPS (BA-TIPS), and to evaluate its feasibility and efficacy in patients with chronic totally occluded portal vein thrombosis (CTO-PVT) with symptomatic portal hypertension. METHODS: Eighteen patients (12 men, six women; mean age 49 years [range, 34-68 years]) with CTO-PVT with symptomatic portal hypertension undergoing BA-TIPS between July 2011 and June 2014 were enrolled in this retrospective study. Rates of technical success, efficacy, and complications were evaluated, and pre- and post-procedure portosystemic gradients compared. Clinical follow-up and periodic assessment of TIPS for patency were performed. RESULTS: BA-TIPS was successful in fourteen patients and converted to open portosystemic shunt placement in four. Mean portosystemic pressure gradient fell from 24.1 ± 2.3 mmHg to 12.1 ± 3.5 mmHg after BA-TIPS (P < 0.01). No procedure-related complications were observed. During a median follow up of 16 months (range, 3-41 months), there was one death from hepatocellular carcinoma, one death from severe heart disease, and shunt dysfunction 16 months after BA-TIPS in one patient. Shunt patency was maintained in the remaining patients without symptoms of recurrence. CONCLUSIONS: BA-TIPS is feasible, safe, and effective for CTO-PVT with symptomatic portal hypertension. KEY POINTS: • Transjugular intrahepatic portosystemic shunt is an important treatment for portal vein thrombosis (PVT). • TIPS is challenging for patients with chronic totally occluded portal vein thrombosis (CTO-PVT). • The use of a balloon increased the technical success of portal puncture. • Balloon-assisted TIPS (BA-TIPS) is feasible, safe, and effective for CTO-PVT.
Authors: E M Walser; S W NcNees; O DeLa Pena; W N Crow; R A Morgan; R Soloway; T Broughan Journal: J Vasc Interv Radiol Date: 1998 Jan-Feb Impact factor: 3.464
Authors: M Senzolo; J Tibbals; E Cholongitas; C K Triantos; A K Burroughs; D Patch Journal: Aliment Pharmacol Ther Date: 2006-03-15 Impact factor: 8.171
Authors: Alexandra Wils; Edwin van der Linden; Bart van Hoek; Peter M T Pattynama Journal: J Clin Gastroenterol Date: 2009 Nov-Dec Impact factor: 3.062
Authors: T C Meine; L S Becker; C L A Dewald; S K Maschke; B Maasoumy; E Jaeckel; H Wedemeyer; F K Wacker; B C Meyer; J B Hinrichs Journal: Cardiovasc Intervent Radiol Date: 2022-01-11 Impact factor: 2.797