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European Radiology
Published in: European Radiology 1/2021

01-01-2021 | Hepatic Encephalopathy | Vascular-Interventional

Retrograde transvenous obliteration for the prevention of variceal rebleeding in patients with portal vein thrombosis: a multicenter study

Authors: Jiaywei Tsauo, Seung Yeon Noh, Ji Hoon Shin, Dong Il Gwon, Kichang Han, Jae Myeong Lee, Ung Bae Jeon, Young Hwan Kim

Published in: European Radiology | Issue 1/2021

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Abstract

Objectives

To evaluate the effectiveness of retrograde transvenous obliteration (RTO) for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis (PVT).

Methods

Consecutive cirrhotic patients with PVT who underwent RTO for the prevention of variceal rebleeding between January 2002 and June 2019 were included in this multicenter retrospective study. The primary outcome measure was rebleeding. The secondary outcome measures were survival, other complications of portal hypertension, liver function, and PVT.

Results

Forty-five patients (mean age, 66.0 ± 10.6 years; mean Model for End-Stage Liver Disease (MELD) score, 13.9 ± 5.5) were included. The 1-year actuarial probability of remaining free of rebleeding was 92.8 ± 4.0%. The 6-week, 1-year, and 3-year actuarial probabilities of survival were 79.8 ± 6.0%, 48.8 ± 7.7%, and 46.1 ± 7.9%, respectively. MELD score (hazard ratio (HR), 1.09 (95% confidence interval (CI), 1.01–1.17); p = .013) and ascites (HR, 2.84 (95% CI, 1.24–6.55); p = .014) were identified as significant predictors of survival. The 1-year actuarial probabilities of remaining free of new or worsening ascites and esophageal varices were 81.2 ± 8.7% and 89.2 ± 6.0%, respectively. No patients had overt hepatic encephalopathy during follow-up. MELD score significantly increased by a mean of 3.8 (95% CI, 1.7–6.0) at 3 months (p = .001). PVT had improved in 32.0%, worsened in 12.0%, and remained unchanged in 56.0% of patients at 3 months.

Conclusion

RTO may be effective for the prevention of variceal rebleeding in cirrhotic patients with PVT.

Key Points

• Retrograde transvenous obliteration may prevent variceal rebleeding in cirrhotic patients with portal vein thrombosis.
• The risks of other complications of portal hypertension may not be high after retrograde transvenous obliteration in cirrhotic patients with portal vein thrombosis.
• Portal vein thrombosis may improve in approximately one-third of cirrhotic patients within 3 months after retrograde transvenous obliteration.
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Metadata
Title
Retrograde transvenous obliteration for the prevention of variceal rebleeding in patients with portal vein thrombosis: a multicenter study
Authors
Jiaywei Tsauo
Seung Yeon Noh
Ji Hoon Shin
Dong Il Gwon
Kichang Han
Jae Myeong Lee
Ung Bae Jeon
Young Hwan Kim
Publication date
01-01-2021
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 1/2021
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-020-07109-9

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