Pretransplantation Portal Vein Recanalization and Transjugular Intrahepatic Portosystemic Shunt Creation for Chronic Portal Vein Thrombosis: Final Analysis of a 61-Patient Cohort

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Abstract

Purpose To report the final analysis of the safety and efficacy of portal vein (PV) recanalization (PVR) and transjugular intrahepatic portosystemic shunt (TIPS) creation (PVR-TIPS) in patients with PV thrombosis (PVT) in need of liver transplantation. Materials and Methods Sixty-one patients with cirrhosis and PVT underwent PVR-TIPS to improve transplantation candidacy. Median patient age was 58 years (range, 22–75 y), and median pre-TIPS Model for End-Stage Liver Disease score was 14 (range, 7–42). The most common etiologies of cirrhosis were nonalcoholic fatty liver disease in 18 patients (30%) and hepatitis C in 13 patients (21%). Twenty-seven patients (44%) had partial PVT, and 34 patients (56%) had complete thrombosis. Forty-nine patients (80%) had Yerdel grade 2 PVT, and 12 (20%) had Yerdel grade 3 PVT. Twenty-nine patients (48%) had cavernous transformation of the PV. Results PVR-TIPS was technically successful in 60 of 61 patients (98%). PV/TIPS patency was maintained in 55 patients (92%) at a median follow-up of 19.2 months (range, 0–105.9 mo). Recurrent PV/TIPS thrombosis occurred in 5 patients (8%), all of whom initially presented with complete PVT. The most common adverse events were TIPS stenosis in 13 patients (22%) and transient encephalopathy in 11 patients (18%). Twenty-four patients (39%) underwent transplantation, 23 of whom (96%) received an end-to-end anastomosis. There were no cases of recurrent PVT following transplantation, with a median imaging follow-up of 32.5 months (range, 0.4–75.4 mo). Five-year overall survival rate was 82%. Conclusions PVR-TIPS is a safe, effective, and durable treatment option for patients with chronic PVT who need liver transplantation.

Original languageEnglish (US)
Pages (from-to)1714-1721.e2
JournalJournal of Vascular and Interventional Radiology
Volume28
Issue number12
DOIs
StatePublished - Dec 1 2017

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Transjugular Intrahepatic Portasystemic Shunt
Portal Vein
Thrombosis
Transplantation
Liver Transplantation
Fibrosis
End Stage Liver Disease

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{2c8748bf7e144c33bb4152f4b71db3dc,
title = "Pretransplantation Portal Vein Recanalization and Transjugular Intrahepatic Portosystemic Shunt Creation for Chronic Portal Vein Thrombosis: Final Analysis of a 61-Patient Cohort",
abstract = "Purpose To report the final analysis of the safety and efficacy of portal vein (PV) recanalization (PVR) and transjugular intrahepatic portosystemic shunt (TIPS) creation (PVR-TIPS) in patients with PV thrombosis (PVT) in need of liver transplantation. Materials and Methods Sixty-one patients with cirrhosis and PVT underwent PVR-TIPS to improve transplantation candidacy. Median patient age was 58 years (range, 22–75 y), and median pre-TIPS Model for End-Stage Liver Disease score was 14 (range, 7–42). The most common etiologies of cirrhosis were nonalcoholic fatty liver disease in 18 patients (30{\%}) and hepatitis C in 13 patients (21{\%}). Twenty-seven patients (44{\%}) had partial PVT, and 34 patients (56{\%}) had complete thrombosis. Forty-nine patients (80{\%}) had Yerdel grade 2 PVT, and 12 (20{\%}) had Yerdel grade 3 PVT. Twenty-nine patients (48{\%}) had cavernous transformation of the PV. Results PVR-TIPS was technically successful in 60 of 61 patients (98{\%}). PV/TIPS patency was maintained in 55 patients (92{\%}) at a median follow-up of 19.2 months (range, 0–105.9 mo). Recurrent PV/TIPS thrombosis occurred in 5 patients (8{\%}), all of whom initially presented with complete PVT. The most common adverse events were TIPS stenosis in 13 patients (22{\%}) and transient encephalopathy in 11 patients (18{\%}). Twenty-four patients (39{\%}) underwent transplantation, 23 of whom (96{\%}) received an end-to-end anastomosis. There were no cases of recurrent PVT following transplantation, with a median imaging follow-up of 32.5 months (range, 0.4–75.4 mo). Five-year overall survival rate was 82{\%}. Conclusions PVR-TIPS is a safe, effective, and durable treatment option for patients with chronic PVT who need liver transplantation.",
author = "Thornburg, {Bartley Garver} and Desai, {Kush R} and Ryan Hickey and Elias Hohlastos and Kulik, {Laura M} and Ganger, {Daniel R} and Talia Baker and Abecassis, {Michael Messod} and Caicedo, {Juan C} and Ladner, {Daniela P} and Fryer, {Jonathan Paul} and Ahsun Riaz and Lewandowski, {Robert J} and Riad Salem",
year = "2017",
month = "12",
day = "1",
doi = "10.1016/j.jvir.2017.08.005",
language = "English (US)",
volume = "28",
pages = "1714--1721.e2",
journal = "Journal of Vascular and Interventional Radiology",
issn = "1051-0443",
publisher = "Elsevier Inc.",
number = "12",

}

TY - JOUR

T1 - Pretransplantation Portal Vein Recanalization and Transjugular Intrahepatic Portosystemic Shunt Creation for Chronic Portal Vein Thrombosis

T2 - Final Analysis of a 61-Patient Cohort

AU - Thornburg, Bartley Garver

AU - Desai, Kush R

AU - Hickey, Ryan

AU - Hohlastos, Elias

AU - Kulik, Laura M

AU - Ganger, Daniel R

AU - Baker, Talia

AU - Abecassis, Michael Messod

AU - Caicedo, Juan C

AU - Ladner, Daniela P

AU - Fryer, Jonathan Paul

AU - Riaz, Ahsun

AU - Lewandowski, Robert J

AU - Salem, Riad

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Purpose To report the final analysis of the safety and efficacy of portal vein (PV) recanalization (PVR) and transjugular intrahepatic portosystemic shunt (TIPS) creation (PVR-TIPS) in patients with PV thrombosis (PVT) in need of liver transplantation. Materials and Methods Sixty-one patients with cirrhosis and PVT underwent PVR-TIPS to improve transplantation candidacy. Median patient age was 58 years (range, 22–75 y), and median pre-TIPS Model for End-Stage Liver Disease score was 14 (range, 7–42). The most common etiologies of cirrhosis were nonalcoholic fatty liver disease in 18 patients (30%) and hepatitis C in 13 patients (21%). Twenty-seven patients (44%) had partial PVT, and 34 patients (56%) had complete thrombosis. Forty-nine patients (80%) had Yerdel grade 2 PVT, and 12 (20%) had Yerdel grade 3 PVT. Twenty-nine patients (48%) had cavernous transformation of the PV. Results PVR-TIPS was technically successful in 60 of 61 patients (98%). PV/TIPS patency was maintained in 55 patients (92%) at a median follow-up of 19.2 months (range, 0–105.9 mo). Recurrent PV/TIPS thrombosis occurred in 5 patients (8%), all of whom initially presented with complete PVT. The most common adverse events were TIPS stenosis in 13 patients (22%) and transient encephalopathy in 11 patients (18%). Twenty-four patients (39%) underwent transplantation, 23 of whom (96%) received an end-to-end anastomosis. There were no cases of recurrent PVT following transplantation, with a median imaging follow-up of 32.5 months (range, 0.4–75.4 mo). Five-year overall survival rate was 82%. Conclusions PVR-TIPS is a safe, effective, and durable treatment option for patients with chronic PVT who need liver transplantation.

AB - Purpose To report the final analysis of the safety and efficacy of portal vein (PV) recanalization (PVR) and transjugular intrahepatic portosystemic shunt (TIPS) creation (PVR-TIPS) in patients with PV thrombosis (PVT) in need of liver transplantation. Materials and Methods Sixty-one patients with cirrhosis and PVT underwent PVR-TIPS to improve transplantation candidacy. Median patient age was 58 years (range, 22–75 y), and median pre-TIPS Model for End-Stage Liver Disease score was 14 (range, 7–42). The most common etiologies of cirrhosis were nonalcoholic fatty liver disease in 18 patients (30%) and hepatitis C in 13 patients (21%). Twenty-seven patients (44%) had partial PVT, and 34 patients (56%) had complete thrombosis. Forty-nine patients (80%) had Yerdel grade 2 PVT, and 12 (20%) had Yerdel grade 3 PVT. Twenty-nine patients (48%) had cavernous transformation of the PV. Results PVR-TIPS was technically successful in 60 of 61 patients (98%). PV/TIPS patency was maintained in 55 patients (92%) at a median follow-up of 19.2 months (range, 0–105.9 mo). Recurrent PV/TIPS thrombosis occurred in 5 patients (8%), all of whom initially presented with complete PVT. The most common adverse events were TIPS stenosis in 13 patients (22%) and transient encephalopathy in 11 patients (18%). Twenty-four patients (39%) underwent transplantation, 23 of whom (96%) received an end-to-end anastomosis. There were no cases of recurrent PVT following transplantation, with a median imaging follow-up of 32.5 months (range, 0.4–75.4 mo). Five-year overall survival rate was 82%. Conclusions PVR-TIPS is a safe, effective, and durable treatment option for patients with chronic PVT who need liver transplantation.

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U2 - 10.1016/j.jvir.2017.08.005

DO - 10.1016/j.jvir.2017.08.005

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VL - 28

SP - 1714-1721.e2

JO - Journal of Vascular and Interventional Radiology

JF - Journal of Vascular and Interventional Radiology

SN - 1051-0443

IS - 12

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