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European Radiology
Published in: European Radiology 9/2018

01-09-2018 | Interventional

Percutaneous transhepatic intrahepatic portosystemic shunt for variceal bleeding with chronic portal vein occlusion after splenectomy

Authors: Junyang Luo, Mingan Li, Youyong Zhang, Haofan Wang, Mingsheng Huang, Zhengran Li, Junwei Chen, Chun Wu, Jiesheng Qian, Shouhai Guan, Zaibo Jiang

Published in: European Radiology | Issue 9/2018

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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.
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Metadata
Title
Percutaneous transhepatic intrahepatic portosystemic shunt for variceal bleeding with chronic portal vein occlusion after splenectomy
Authors
Junyang Luo
Mingan Li
Youyong Zhang
Haofan Wang
Mingsheng Huang
Zhengran Li
Junwei Chen
Chun Wu
Jiesheng Qian
Shouhai Guan
Zaibo Jiang
Publication date
01-09-2018
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 9/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5360-z

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