Junyang Luo1, Mingan Li1, Youyong Zhang1,2, Haofan Wang1, Mingsheng Huang1, Zhengran Li1, Junwei Chen1, Chun Wu1, Jiesheng Qian1, Shouhai Guan1, Zaibo Jiang3. 1. Department of Interventional Radiology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China. 2. Department of Radiology, Yuebei People's Hospital, Shaoguan, 512026, China. 3. Department of Interventional Radiology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China. jiangzaibo@foxmail.com.
Abstract
OBJECTIVES: The purpose of this study was to introduce a modified transjugular intrahepatic portosystemic shunt (TIPS), a percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS), and to evaluate its feasibility and efficacy in patients with variceal bleeding with chronic portal vein occlusion (CPVO) after splenectomy. METHODS: Twenty-four cirrhotic patients with CPVO after splenectomy who received PTIPS between 2010 and 2015 were included in this retrospective study. The indication was elective control of variceal bleeding. Success rates, effectiveness and complications were evaluated, with comparison of the pre- and post-portosystemic pressure gradient (PPG). Patients' clinical outcomes and shunt patency were followed periodically. RESULTS: PTIPS was successfully placed in 22 patients (91.7%) and failed in two. The mean PPG fell from 22.0 ± 4.9 mmHg to 10.6 ± 1.6 mmHg after successful PTIPS (p < 0.05). No fatal procedural complications occurred. During the median follow-up of 29 months, shunt dysfunction occurred in five cases and hepatic encephalopathy in four cases. Three patients died because of rebleeding, hepatic failure and pulmonary disease, respectively. The other patients remained asymptomatic and the shunts patent. CONCLUSIONS: We conclude that PTIPS, as a modified TIPS procedure with a high success rate, is safe and effective for variceal bleeding with CPVO after splenectomy. KEY POINTS: • Portal vein occlusion used to be contraindication to transjugular intrahepatic portosystemic shunt. • Portal vein thrombosis is common in patients with previous splenectomy. • We developed a new method, percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS). • PTIPS is feasible in patients with portal vein thrombosis and splenectomy. • PTIPS is effective and safe for these kind of complicated portal hypertension.
OBJECTIVES: The purpose of this study was to introduce a modified transjugular intrahepatic portosystemic shunt (TIPS), a percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS), and to evaluate its feasibility and efficacy in patients with variceal bleeding with chronic portal vein occlusion (CPVO) after splenectomy. METHODS: Twenty-four cirrhotic patients with CPVO after splenectomy who received PTIPS between 2010 and 2015 were included in this retrospective study. The indication was elective control of variceal bleeding. Success rates, effectiveness and complications were evaluated, with comparison of the pre- and post-portosystemic pressure gradient (PPG). Patients' clinical outcomes and shunt patency were followed periodically. RESULTS:PTIPS was successfully placed in 22 patients (91.7%) and failed in two. The mean PPG fell from 22.0 ± 4.9 mmHg to 10.6 ± 1.6 mmHg after successful PTIPS (p < 0.05). No fatal procedural complications occurred. During the median follow-up of 29 months, shunt dysfunction occurred in five cases and hepatic encephalopathy in four cases. Three patients died because of rebleeding, hepatic failure and pulmonary disease, respectively. The other patients remained asymptomatic and the shunts patent. CONCLUSIONS: We conclude that PTIPS, as a modified TIPS procedure with a high success rate, is safe and effective for variceal bleeding with CPVO after splenectomy. KEY POINTS: • Portal vein occlusion used to be contraindication to transjugular intrahepatic portosystemic shunt. • Portal vein thrombosis is common in patients with previous splenectomy. • We developed a new method, percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS). • PTIPS is feasible in patients with portal vein thrombosis and splenectomy. • PTIPS is effective and safe for these kind of complicated portal hypertension.
Authors: María Gabriela Delgado; Susana Seijo; Ismael Yepes; Linette Achécar; Maria Vega Catalina; Angeles García-Criado; Juan G Abraldes; Joaquín de la Peña; Rafael Bañares; Agustín Albillos; Jaume Bosch; Juan Carlos García-Pagán Journal: Clin Gastroenterol Hepatol Date: 2012-01-28 Impact factor: 11.382
Authors: I Lisanne Holster; Eric T T L Tjwa; Adriaan Moelker; Alexandra Wils; Bettina E Hansen; J Reinoud Vermeijden; Pieter Scholten; Bart van Hoek; Jan J Nicolai; Ernst J Kuipers; Peter M T Pattynama; Henk R van Buuren Journal: Hepatology Date: 2015-12-28 Impact factor: 17.425
Authors: Jung Wha Chung; Gi Hyun Kim; Jong Ho Lee; Kyeong Sam Ok; Eun Sun Jang; Sook-Hyang Jeong; Jin-Wook Kim Journal: Clin Mol Hepatol Date: 2014-12-24