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Published in:

01-06-2012 | Review Article

Transjugular intrahepatic portosystemic shunt in the treatment of portal vein thrombosis: a critical review of literature

Authors: Xingshun Qi, Guohong Han

Published in: Hepatology International | Issue 3/2012

Abstract

Reports of successful transjugular intrahepatic portosystemic shunt (TIPS) surgery in patients with portal vein thrombosis (PVT) are considered anecdotal owing to the technical difficulty of the procedure and potential procedure-related complications. A literature review was undertaken to determine the feasibility and safety of TIPS in the treatment of PVT. All studies in which TIPS was attempted in patients with PVT were identified by searching through the PUBMED and MEDLINE databases. A total of 424 PVT patients undergoing TIPS were reported in 54 articles. The success rate of TIPS insertion was 67–100% in 19 case series. Further, 85 patients with portal cavernoma underwent successful TIPS insertions. Three therapeutic strategies of TIPS placement were used: (1) TIPS placement followed by portal vein recanalization via the shunt, (2) portal vein recanalization via percutaneous approaches followed by TIPS placement, and (3) TIPS insertion between a hepatic vein and a large collateral vessel without portal vein recanalization. Four approaches were used to access the portal vein: transjugular, transhepatic, transsplenic, and transmesenteric. Intra-abdominal hemorrhage secondary to hepatic capsule perforation was lethal in only three patients. No episode of pulmonary embolism was reported. Other procedure-related complications were reversible. The overall incidence of shunt dysfunction and hepatic encephalopathy was 8–33% and 0–50%, respectively. In conclusion, the reviewed studies uniformly support the feasibility and safety of TIPS for PVT even in the presence of portal cavernoma. Further, several major issues that remain unresolved are discussed.

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Rossle M, Richter GM, Noldge G, et al. Performance of an intrahepatic portocaval shunt (PCS) using a catheter technique: A case report. Hepatology 1988;8:1348

Boyer TD, Haskal ZJ. The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension. Hepatology 2005;41:386–400PubMedCrossRef

Luca A, D’Amico G, La Galla R, Midiri M, Morabito A, Pagliaro L. TIPS for prevention of recurrent bleeding in patients with cirrhosis: Meta-analysis of randomized clinical trials. Radiology 1999;212:411–21PubMed

Salerno F, Camma C, Enea M, Rossle M, Wong F. Transjugular intrahepatic portosystemic shunt for refractory ascites: A meta-analysis of individual patient data. Gastroenterology 2007;133:825–834PubMedCrossRef

Garcia-Pagan JC, Heydtmann M, Raffa S, et al. TIPS for Budd-Chiari syndrome: Long-term results and prognostics factors in 124 patients. Gastroenterology 2008;135:808–815PubMedCrossRef

Darwish Murad S, Plessier A, Hernandez-Guerra M, et al. Etiology, management, and outcome of the Budd-Chiari syndrome. Ann Intern Med 2009;151:167–75PubMed

Boyer TD, Haskal ZJ. The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension: update. Hepatology 2010;51:306PubMedCrossRef

Garcia-Pagan JC, Caca K, Bureau C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med 2010;362:2370–2379PubMedCrossRef

DeLeve LD, Valla DC, Garcia-Tsao G. Vascular disorders of the liver. Hepatology 2009;49:1729–1764PubMedCrossRef

10.

Sarin SK, Sollano JD, Chawla YK, et al. Consensus on extra-hepatic portal vein obstruction. Liver Int 2006;26:512–519PubMedCrossRef

11.

Condat B, Pessione F, Denninger MH, Hillaire S, Valla D. Recent portal or mesenteric venous thrombosis: Increased recognition and frequent recanalization on anticoagulant therapy. Hepatology 2000;32:466–470PubMedCrossRef

12.

Amitrano L, Guardascione MA, Scaglione M, et al. Prognostic factors in noncirrhotic patients with splanchnic vein thromboses. Am J Gastroenterol 2007;102:2464–2470PubMedCrossRef

13.

Plessier A, Darwish-Murad S, Hernandez-Guerra M, et al. Acute portal vein thrombosis unrelated to cirrhosis: A prospective multicenter follow-up study. Hepatology 2010;51:210–218PubMedCrossRef

14.

Thatipelli MR, McBane RD, Hodge DO, Wysokinski WE. Survival and recurrence in patients with splanchnic vein thromboses. Clin Gastroenterol Hepatol 2010;8:200–205PubMedCrossRef

15.

Riggio O, Ridola L, Lucidi C, Angeloni S. Emerging issues in the use of transjugular intrahepatic portosystemic shunt (TIPS) for management of portal hypertension: Time to update the guidelines? Dig Liver Dis 2010;42:462–467PubMedCrossRef

16.

Qi X, Han G, Fan D. The preferable treatment for cirrhotic portal vein thrombosis: anticoagulation or transjugular intrahepatic portosystemic shunt? Hepatology 2010;51:713–714PubMedCrossRef

17.

Honda M, Nishida H, Takashina T, et al. A case of alcoholic liver cirrhosis associated with portal vein thrombosis which was successfully treated by TIPS. Nippon Igaku Hoshasen Gakkai Zasshi 1993;53:220–222PubMed

18.

Nakamura K, Takashima S, Hayashi S, et al. Transjugular intrahepatic portosystemic shunt–early experience in eleven liver cirrhosis patients. Nippon Shokakibyo Gakkai Zasshi 1994;91:1210–1219PubMed

19.

Allgaier HP, Ochs A, Haag K, et al. Recurrent bleeding from colonic varices in portal hypertension. The successful prevention of recurrence by the implantation of a transjugular intrahepatic stent-shunt (TIPS). Dtsch Med Wochenschr 1995;120:1773–1776PubMedCrossRef

20.

Mann O, Haag K, Hauenstein KH, Rossle M, Pausch J. Septic portal vein thrombosis. Its successful therapy by local fibrinolysis and a transjugular portasystemic stent-shunt (TIPS). Dtsch Med Wochenschr 1995;120:1201–1206PubMedCrossRef

21.

Hanig V, Stenzel G, Rossle M. Acute portal vein thrombosis in liver cirrhosis: successful recanalization with the use of a portosystemic shunt (TIPS). Rofo 1996;165:403–405PubMedCrossRef

22.

Vogl T, Hidajat N, Schroder RJ, Felix R. Recanalization of an extensive fresh portal vein thrombosis by transjugular intrahepatic portosystemic stent-shunt (TIPS). Rofo 1999;171:163–165PubMedCrossRef

23.

Mamiya Y, Kanazawa H, Narahara Y, et al. A case of successful TIPS placement for gastrointestinal hemorrhage from portal hypertensive gastropathy due to complete portal venous thrombosis. Nippon Shokakibyo Gakkai Zasshi 2000;97:466–471PubMed

24.

Chung WJ, Jang BK, Park KS, et al. Effect of transjugular intrahepatic portosystemic shunt for variceal bleeding in hepatocellular carcinoma patients with portal vein thrombosis. Korean J Hepatol 2005;11:157–163PubMed

25.

Ramanampamonjy RM, Ramarozatovo LS, Bonnet F, et al. Portal vein thrombosis in HIV-infected patients: Report of four cases. Rev Med Interne 2005;26:545–548PubMedCrossRef

26.

Streitparth F, Santosa F, Milz J, et al. Transjugular intrahepatic portosystemic shunt in patients with portal vein thrombosis. Rofo 2008;180:899–905PubMedCrossRef

27.

Han GH, Meng XJ, Yin ZX, et al. Transjugular intrahepatic portosystemic shunt and combination with percutaneous transhepatic or transsplenic approach for the treatment of portal vein thrombosis with or without cavernomatous transformation. Zhonghua Yi Xue Za Zhi 2009;89:1549–1552PubMed

28.

Radosevich PM, Ring EJ, LaBerge JM, et al. Transjugular intrahepatic portosystemic shunts in patients with portal vein occlusion. Radiology 1993;186:523–527PubMed

29.

Bilbao JI, Longo JM, Rousseau H, et al. Transjugular intrahepatic portocaval shunt after thrombus disruption in partially thrombosed portal veins. Cardiovasc Intervent Radiol 1994;17:106–109PubMed

30.

Bezzi M, Broglia L, Lemos AA, Rossi P. Transjugular intrahepatic portosystemic shunt in portal vein thrombosis: Role of the right gastric vein with anomalous insertion. Cardiovasc Intervent Radiol 1995;18:102–105PubMedCrossRef

31.

Blum U, Haag K, Rossle M, et al. Noncavernomatous portal vein thrombosis in hepatic cirrhosis: treatment with transjugular intrahepatic portosystemic shunt and local thrombolysis. Radiology 1995;195:153–157PubMed

32.

Bayraktar Y, Oksuzoglu G, Balkanci F, et al. Portal hypertension due to incomplete membranous obstruction of the portal vein. J Clin Gastroenterol 1995;21:260–262PubMedCrossRef

33.

Gorgul A, Kayhan B, Dogan I, Unal S. Disappearance of the pseudo-cholangiocarcinoma sign after TIPSS. Am J Gastroenterol 1996;91:150–154PubMed

34.

Matsui O, Yoshikawa J, Kadoya M, et al. Transjugular intrahepatic portosystemic shunt after previous recanalization of a chronically thrombosed portal vein via a transmesenteric approach. Cardiovasc Intervent Radiol 1996;19:352–355PubMedCrossRef

35.

Rozenblit G, DelGuercio LR, Savino JA, et al. Transmesenteric-transfemoral method of intrahepatic portosystemic shunt placement with minilaparotomy. J Vasc Interv Radiol 1996;7:499–506PubMedCrossRef

36.

Lang EV, Barnhart WH. Adjunct transjugular cholangiography for transjugular intrahepatic portosystemic shunt in chronic portal vein occlusion. AJR Am J Roentgenol 1997;168:570–571PubMed

37.

Walser EM, NcNees SW, DeLa Pena O, et al. Portal venous thrombosis: percutaneous therapy and outcome. J Vasc Interv Radiol 1998;9:119–127PubMedCrossRef

38.

Yamagami T, Nakamura T, Tanaka O, Akada W, Takayama T, Maeda T. Transjugular intrahepatic portosystemic shunt after complete obstruction of portal vein. J Vasc Interv Radiol 1999;10:575–578PubMedCrossRef

39.

Ganger DR, Klapman JB, McDonald V, et al. Transjugular intrahepatic portosystemic shunt (TIPS) for Budd-Chiari syndrome or portal vein thrombosis: Review of indications and problems. Am J Gastroenterol 1999;94:603–608PubMed

40.

Stein M, Link DP. Symptomatic spleno-mesenteric-portal venous thrombosis: Recanalization and reconstruction with endovascular stents. J Vasc Interv Radiol 1999;10:363–371PubMedCrossRef

41.

Sehgal M, Haskal ZJ. Use of transjugular intrahepatic portosystemic shunts during lytic therapy of extensive portal splenic and mesenteric venous thrombosis: Long-term follow-up. J Vasc Interv Radiol 2000;11:61–65PubMedCrossRef

42.

Morris CS, Najarian KE. Transjugular intrahepatic portosystemic shunt for bleeding stomal varices associated with chronic portal vein occlusion: Long-term angiographic, hemodynamic, and clinical follow-up. Am J Gastroenterol 2000;95:2966–2968PubMedCrossRef

43.

Kawamata H, Kumazaki T, Kanazawa H, Takahashi S, Tajima H, Hayashi H. Transjugular intrahepatic portosystemic shunt in a patient with cavernomatous portal vein occlusion. Cardiovasc Intervent Radiol 2000;23:145–149PubMedCrossRef

44.

Cwikiel W, Solvig J, Schroder H. Stent recanalization of chronic portal vein occlusion in a child. Cardiovasc Intervent Radiol 2000;23:309–311PubMedCrossRef

45.

Bayraktar Y, Ozturk MA, Egesel T, Cekirge S, Balkanci F. Disappearance of “pseudocholangiocarcinoma sign” in a patient with portal hypertension due to complete thrombosis of left portal vein and main portal vein web after web dilatation and transjugular intrahepatic portosystemic shunt. J Clin Gastroenterol 2000;31:328–332PubMedCrossRef

46.

Trevisani F, Rossi C, Losinno F, Bernardi M. Transjugular intrahepatic splenosystemic shunt in a patient with portal vein thrombosis. J Hepatol 2001;35:682PubMedCrossRef

47.

Liatsos C, Vlachogiannakos J, Patch D, et al. Successful recanalization of portal vein thrombosis before liver transplantation using transjugular intrahepatic portosystemic shunt. Liver Transpl. 2001;7:453–360PubMedCrossRef

48.

Ciccarelli O, Goffette P, Laterre PF, Danse E, Wittebolle X, Lerut J. Transjugular intrahepatic portosystemic shunt approach and local thrombolysis for treatment of early posttransplant portal vein thrombosis. Transplantation 2001;72:159–161CrossRef

49.

Chen S, Soares GM. Balloon-targeted access of right portal vein for transluminal intrahepatic portosystemic shunt creation in the setting of portal vein thrombosis J Vasc Interv Radiol 2003;14:513–4PubMedCrossRef

50.

Cwikiel W, Keussen I, Larsson L, Solvig J, Kullendorff CM. Interventional treatment of children with portal hypertension secondary to portal vein occlusion. Eur J Pediatr Surg 2003;13:312–318PubMedCrossRef

51.

Brountzos EN, Malagari K, Alexopoulou E, et al. Transjugular intrahepatic portosystemic shunt in cavernomatous portal vein occlusion. Hepatogastroenterology 2004;51:1168–1171PubMed

52.

Bilbao JI, Elorz M, Vivas I, Martinez-Cuesta A, Bastarrika G, Benito A. Transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of venous symptomatic chronic portal thrombosis in non-cirrhotic patients. Cardiovasc Intervent Radiol 2004;27:474–480PubMedCrossRef

53.

Jiang ZB, Shan H, Shen XY, et al. Transjugular intrahepatic portosystemic shunt for palliative treatment of portal hypertension secondary to portal vein tumor thrombosis. World J Gastroenterol 2004;10:1881–1884PubMed

54.

Hur J, Lee KH, Lee JH, Yu JS, Won JY, Lee D. Stent-graft for TIPS in a hepatocellular carcinoma patient with main portal vein invasion. AJR Am J Roentgenol 2004;182:1301–1304PubMed

55.

Wallace MJ, Madoff DC, Ahrar K, Warneke CL. Transjugular intrahepatic portosystemic shunts: Experience in the oncology setting. Cancer 2004;101:337–345PubMedCrossRef

56.

Senzolo M, Tibbals J, Cholongitas E, Triantos CK, Burroughs AK, Patch D. Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with and without cavernous transformation. Aliment Pharmacol Ther 2006;23:767–775PubMedCrossRef

57.

Walser EM, Soloway R, Raza SA, Gill A. Transjugular portosystemic shunt in chronic portal vein occlusion: Importance of segmental portal hypertension in cavernous transformation of the portal vein. J Vasc Interv Radiol 2006;17:373–378PubMedCrossRef

58.

Senzolo M, Cholongitas E, Tibballs J, et al. Relief of biliary obstruction due to portal vein cavernoma using a transjugular intrahepatic portosystemic shunt (TIPS) without the need for long-term stenting. Endoscopy 2006;38:760–767PubMedCrossRef

59.

Al Hamad A, Kabbani A, Al Kadhi Y. N-butyl-2-cyanoacrylate (Histoacryl) complication: a case report. Ann Saudi Med 2006;26:71–72PubMed

60.

Yamagami T, Takeuchi Y, Sonoyama T, et al. Non-cavernomatous superior mesenteric thrombosis successfully recanalized with interventional radiological procedures carried out with a combination transmesenteric and transjugular approaches. Australas Radiol 2006;50:495–499PubMedCrossRef

61.

Van Ha TG, Hodge J, Funaki B, et al. Transjugular intrahepatic portosystemic shunt placement in patients with cirrhosis and concomitant portal vein thrombosis. Cardiovasc Intervent Radiol 2006;29:785–790PubMedCrossRef

62.

Sze DY, Magsamen KE, Frisoli JK. Successful transfemoral creation of an intrahepatic portosystemic shunt with use of the Viatorr device. J Vasc Interv Radiol 2006;17:569–572PubMedCrossRef

63.

Bauer J, Johnson S, Durham J, et al. The role of TIPS for portal vein patency in liver transplant patients with portal vein thrombosis. Liver Transpl 2006;12:1544–1551PubMedCrossRef

64.

Tuite DJ, Rehman J, Davies MH, Patel JV, Nicholson AA, Kessel DO. Percutaneous transsplenic access in the management of bleeding varices from chronic portal vein thrombosis. J Vasc Interv Radiol 2007;18:1571–1575PubMedCrossRef

65.

Ferro C, Rossi UG, Bovio G, Dahamane M, Centanaro M. Transjugular intrahepatic portosystemic shunt, mechanical aspiration thrombectomy, and direct thrombolysis in the treatment of acute portal and superior mesenteric vein thrombosis. Cardiovasc Intervent Radiol 2007;30:1070–1074PubMedCrossRef

66.

Semiz-Oysu A, Keussen I, Cwikiel W. Interventional radiological management of prehepatic obstruction of [corrected] the splanchnic venous system. Cardiovasc Intervent Radiol 2007;30:688–695PubMedCrossRef

67.

Gazzera C, Righi D, Valle F, Ottobrelli A, Grosso M, Gandini G. Fifteen years’ experience with transjugular intrahepatic portosystemic shunt (TIPS) using bare stents: Retrospective review of clinical and technical aspects. Radiol Med 2009;114:83–94PubMedCrossRef

68.

Adamus R, Pfister M, Loose RWR. Enhancing transjugular intrahepatic portosystemic shunt puncture by using three-dimensional path planning based on the back projection of two two-dimensional portographs. Radiology 2009;251:543–547PubMedCrossRef

69.

Wils A, van der Linden E, van Hoek B, Pattynama PM. Transjugular intrahepatic portosystemic shunt in patients with chronic portal vein occlusion and cavernous transformation. J Clin Gastroenterol 2009;43:982–984PubMedCrossRef

70.

Lopez-Benitez R, Barragan-Campos HM, Richter GM, et al. Interventional radiologic procedures in the treatment of complications after liver transplantation. Clin Transplant 2009;23(Suppl 21):92–101PubMedCrossRef

71.

McHugh PP, Bietz GJ, Jeon H, Johnston TD, Gedaly R, Ranjan D. Transjugular intrahepatic portosystemic shunt to keep vein open. Liver Transpl 2009;15:558–560PubMedCrossRef

72.

Liu FY, Wang MQ, Fan QS, Duan F, Wang ZJ, Song P. Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis. World J Gastroenterol 2009;15:5028–5034PubMedCrossRef

73.

Finkenstedt A, Graziadei IW, Nachbaur K, et al. Transjugular intrahepatic portosystemic shunt in liver transplant recipients. World J Gastroenterol 2009;15:1999–2004PubMedCrossRef

74.

Kav T, Peynircioglu B, Balkanci F, Bayraktar Y. Long-term patency of transjugular intrahepatic portosystemic shunt in a patient with portal vein web. J Clin Gastroenterol 2009;43:791–792PubMedCrossRef

75.

Lodhia N, Salem R, Levitsky J. Transjugular intrahepatic portosystemic shunt with thrombectomy for the treatment of portal vein thrombosis after liver transplantation. Dig Dis Sci 2010;55:529–534PubMedCrossRef

76.

Perarnau JM, Baju A, D’Alteroche L, Viguier J, Ayoub J. Feasibility and long-term evolution of TIPS in cirrhotic patients with portal thrombosis. Eur J Gastroenterol Hepatol 2010;22:1093–1098PubMedCrossRef

77.

Fanelli F, Angeloni S, Salvatori FM, et al. Transjugular intrahepatic portosystemic shunt with expanded-polytetrafuoroethylene-covered stents in non-cirrhotic patients with portal cavernoma. Dig Liver Dis 2011;43:78–84PubMedCrossRef

78.

Han G, Qi X, He C, et al. Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with symptomatic portal hypertension in liver cirrhosis. J Hepatol 2011;54:78–88PubMedCrossRef

79.

Luo JJ, Yan ZP, Wang JH, Liu QX, Qu XD. Endovascular treatment for nonacute symptomatic portal venous thrombosis through intrahepatic portosystemic shunt approach. J Vasc Interv Radiol 2011;22:61–69PubMedCrossRef

80.

Luca A, Miraglia R, Caruso S, et al. Short- and long-term effects of the transjugular intrahepatic portosystemic shunt on portal vein thrombosis in patients with cirrhosis. Gut 2011;60:846–852PubMedCrossRef

81.

Miraglia R, Maruzzelli L, Luca A. Transjugular intrahepatic porto-systemic shunt placement in a patient with left-lateral split-liver transplant and mesenterico-left portal vein by pass placement. Cardiovasc Intervent Radiol 2011 (in press)

82.

Han G, Qi X, Guo W, Niu J, Bai M, Fan D. Transjugular intrahepatic portosystemic shunt for portal vein thrombosis in cirrhosis. Gut 2011 (in press)

83.

Qi X, Han G, Bai M, Fan D. Stage of portal vein thrombosis. J Hepatol 2011;54:1080–1082PubMedCrossRef

84.

Valla DC, Condat B. Portal vein thrombosis in adults: pathophysiology, pathogenesis and management. J Hepatol 2000;32:865–871PubMedCrossRef

85.

Boyer TD, Haskal ZJ. American Association for the Study of Liver Diseases practice guidelines: the role of transjugular intrahepatic portosystemic shunt creation in the management of portal hypertension. J Vasc Interv Radiol 2005;16:615–629PubMedCrossRef

86.

Francoz C, Belghiti J, Vilgrain V, et al. Splanchnic vein thrombosis in candidates for liver transplantation: usefulness of screening and anticoagulation. Gut 2005;54:691–697PubMedCrossRef

87.

Englesbe MJ, Kubus J, Muhammad W, et al. Portal vein thrombosis and survival in patients with cirrhosis. Liver Transpl 2010;16:83–90PubMedCrossRef

88.

Englesbe MJ, Schaubel DE, Cai S, Guidinger MK, Merion RM. Portal vein thrombosis and liver transplant survival benefit. Liver Transpl 2010;16:999–1005PubMedCrossRef

89.

Gayowski TJ, Marino IR, Doyle HR, et al. A high incidence of native portal vein thrombosis in veterans undergoing liver transplantation. J Surg Res 1999;60:333–338CrossRef

90.

Qi X, Bai M, Yang Z, et al. Occlusive portal vein thrombosis as a new marker of decompensated cirrhosis. Med Hypotheses 2011;76:522–526PubMedCrossRef

91.

O’Leary JG, Lepe R, Davis GL. Indications for liver transplantation. Gastroenterology 2008;134:1764–1776PubMedCrossRef

92.

Jamieson NV. Changing perspectives in portal vein thrombosis and liver transplantation. Transplantation 2000;69:1772–1774PubMedCrossRef

93.

Senzolo M, Riggio O, Primignani M. Vascular disorders of the liver: Recommendations from the Italian Association for the Study of the Liver (AISF) ad hoc committee. Dig Liver Dis 2011;43:503–514PubMedCrossRef

94.

Senzolo M, Patch D, Burra P, Burroughs AK. TIPS for portal vein thrombosis (PVT) in cirrhosis: not only unblocking a pipe. J Hepatol 2011;55:945–946PubMedCrossRef

95.

Han G, Qi X, He C, Fan D. TIPS for portal vein thrombosis (PVT): still a long way to go. J Hepatol 2011;55:947–948CrossRef

96.

Yang Z, Han G, Wu Q, et al. Patency and clinical outcomes of transjugular intrahepatic portosystemic shunt with polytetrafluoroethylene-covered stents versus bare stents: a meta-analysis. J Gastroenterol Hepatol 2010;25:1718–1725PubMedCrossRef

97.

Zhang D, Hao J, Yang N. Protein C and D-dimer are related to portal vein thrombosis in patients with liver cirrhosis. J Gastroenterol Hepatol 2010;15:116–121CrossRef

98.

Amitrano L, Brancaccio V, Guardascione MA, et al. Inherited coagulation disorders in cirrhotic patients with portal vein thrombosis. Hepatology 2000;31:345–348PubMedCrossRef

Title: Transjugular intrahepatic portosystemic shunt in the treatment of portal vein thrombosis: a critical review of literature
Authors: Xingshun Qi
Guohong Han
Publication date: 01-06-2012
Publisher: Springer-Verlag
Published in: Hepatology International / Issue 3/2012
Print ISSN: 1936-0533
Electronic ISSN: 1936-0541
DOI: https://doi.org/10.1007/s12072-011-9324-5

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