Ian W Sullivan1, Adam Fonseca2, McKenzie Brown3, Joseph Ness3, Marc Borge2, Parag Amin4, Christopher Molvar2. 1. Loyola University Medical Center Department of Interventional Radiology, 2160 S 1st Avenue, Maywood, IL, 60153, USA. isullivan@tuftsmedicalcenter.org. 2. Loyola University Medical Center Department of Interventional Radiology, 2160 S 1st Avenue, Maywood, IL, 60153, USA. 3. Loyola University Medical Center Department of Diagnostic Radiology, 2160 S 1st Avenue, Maywood, IL, 60153, USA. 4. Cleveland Clinic Florida Department of Interventional Radiology, Weston Hospital, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA.
Abstract
PURPOSE: Portal vein thrombus (PVT) can worsen portal hypertension and hepatic decompensation in patients with cirrhosis and impact liver transplant outcomes. This retrospective case series describes large bore mechanical thrombectomy of PVT with the Inari FlowTriever device during, or remotely after, transjugular intrahepatic portosystemic shunt (TIPS) placement. MATERIALS AND METHODS: Ten patients with PVT were treated with large bore thrombectomy. All patients had underlying cirrhosis, complicated by portal hypertension with acute/subacute PVT. Thrombectomy was performed either with TIPS placement, or via a previously placed thrombosed shunt. Median time from TIPS placement to thrombectomy was 3 years. RESULTS: Thrombectomy was technically successful in all patients with a majority achieving complete resolution of PVT in a single session. During mean follow-up of 13.3 months, all patients achieved complete resolution of PVT without recurrence. CONCLUSION: Large bore mechanical thrombectomy together with TIPS is a feasible and effective treatment of acute/subacute PVT in cirrhotic patients with portal hypertension, often with complete resolution in a single session.
PURPOSE: Portal vein thrombus (PVT) can worsen portal hypertension and hepatic decompensation in patients with cirrhosis and impact liver transplant outcomes. This retrospective case series describes large bore mechanical thrombectomy of PVT with the Inari FlowTriever device during, or remotely after, transjugular intrahepatic portosystemic shunt (TIPS) placement. MATERIALS AND METHODS: Ten patients with PVT were treated with large bore thrombectomy. All patients had underlying cirrhosis, complicated by portal hypertension with acute/subacute PVT. Thrombectomy was performed either with TIPS placement, or via a previously placed thrombosed shunt. Median time from TIPS placement to thrombectomy was 3 years. RESULTS: Thrombectomy was technically successful in all patients with a majority achieving complete resolution of PVT in a single session. During mean follow-up of 13.3 months, all patients achieved complete resolution of PVT without recurrence. CONCLUSION: Large bore mechanical thrombectomy together with TIPS is a feasible and effective treatment of acute/subacute PVT in cirrhotic patients with portal hypertension, often with complete resolution in a single session.
Authors: Patrick G Northup; Juan Carlos Garcia-Pagan; Guadalupe Garcia-Tsao; Nicolas M Intagliata; Riccardo A Superina; Lara N Roberts; Ton Lisman; Dominique C Valla Journal: Hepatology Date: 2021-01-20 Impact factor: 17.425
Authors: Bartley Thornburg; Kush Desai; Ryan Hickey; Elias Hohlastos; Laura Kulik; Daniel Ganger; Talia Baker; Michael Abecassis; Juan C Caicedo; Daniela Ladner; Jonathan Fryer; Ahsun Riaz; Robert J Lewandowski; Riad Salem Journal: J Vasc Interv Radiol Date: 2017-10-17 Impact factor: 3.464