Skip to main content
SpringerLink
Log in

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

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

CPVO:

Chronic portal vein occlusion

PPG:

Portosystemic pressure gradient

PTIPS:

Percutaneous transhepatic intrahepatic portosystemic shunt

PVT:

Portal vein thrombosis

References

  1. Cheng LF, Jia JD, Xu XY et al (2009) Esophagogastric variceal bleeding in cirrhotic portal hypertension: consensus on prevention and management (2008). Chin Med J (Engl) 122:766–775

    CAS  Google Scholar 

  2. Yang Z, Qiu F (2000) Pericardial devascularization with splenectomy for the treatment of portal hypertension. Chin J Surg 38:645–648

    PubMed  CAS  Google Scholar 

  3. Qi X, Han G, Ye C et al (2016) Splenectomy causes 10-fold increased risk of portal venous system thrombosis in liver cirrhosis patients. Med Sci Monit 22:2528–2550

    Article  PubMed  PubMed Central  Google Scholar 

  4. European Association for the Study of the Liver (2016) EASL clinical practice guidelines: vascular diseases of the liver. J Hepatol 64:179–202

    Article  Google Scholar 

  5. Rodríguez-Castro KI, Porte RJ, Nadal E, Germani G, Burra P, Senzolo M (2012) Management of nonneoplastic portal vein thrombosis in the setting of liver transplantation: a systematic review. Transplantation 94:1145–1153

    Article  PubMed  Google Scholar 

  6. Bauer J, Johnson SJ, Ludkowski M et al (2006) The role of TIPS for portal vein patency in liver transplant patients with portal vein thrombosis. Liver Transpl 12:1544–1551

    Article  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  8. Radosevich PM, Ring EJ, Laberge JM et al (1993) Transjugular intrahepatic portosystemic shunts in patients with portal vein occlusion. Radiology 186:523–527

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  14. Han GH, Meng XJ, Yin ZX et al (2009) 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 89:1549–1552

    PubMed  Google Scholar 

  15. Chen Y, Ye P, Li Y, Ma S, Zhao J, Zeng Q (2015) Percutaneous transhepatic balloon-assisted transjugular intrahepatic portosystemic shunt for chronic, totally occluded, portal vein thrombosis with symptomatic portal hypertension: procedure technique, safety, and clinical applications. Eur Radiol 25:3431–3437

    Article  PubMed  Google Scholar 

  16. Salem R, Vouche M, Baker T et al (2015) Pretransplant portal vein recanalization-transjugular intrahepatic portosystemic shunt in patients with complete obliterative portal vein thrombosis. Transplantation 99:2347–2355

    Article  PubMed  Google Scholar 

  17. Habib A, Desai K, Hickey R et al (2015) Portal vein recanalization–transjugular intrahepatic portosystemic shunt using the transsplenic approach to achieve transplant candidacy in patients with chronic portal vein thrombosis. J Vasc Interv Radiol 26:499–506

    Article  PubMed  Google Scholar 

  18. Qi X, Han G, He C et al (2012) Transjugular intrahepatic portosystemic shunt may be superior to conservative therapy for variceal rebleeding in cirrhotic patients with non-tumoral portal vein thrombosis: A hypothesis. Med Sci Monit 18:37–41

    Article  Google Scholar 

  19. Garcia-Pagán JC, Hernández-Guerra M, Bosch J (2008) Extrahepatic portal vein thrombosis. Semin Liver Dis 28:282–292

    Article  PubMed  Google Scholar 

  20. Wang Z, Zhao H, Wang X et al (2015) Clinical outcome comparison between TIPS and EBL in patients with cirrhosis and portal vein thrombosis. Abdom Imaging 40:1813–1820

    Article  PubMed  Google Scholar 

  21. Holster IL, Tjwa ET, Moelker A et al (2016) Covered transjugular intrahepatic portosystemic shunt versus endoscopic therapy + β-blocker for prevention of variceal rebleeding. Hepatology 63:581–589

    Article  PubMed  CAS  Google Scholar 

  22. Haskal ZJ, Duszak R Jr, Furth EE (1996) Transjugular intrahepatic transcaval portosystemic shunt: The gun-sight approach. J Vasc Interv Radiol 7:139–142

    Article  PubMed  CAS  Google Scholar 

  23. Leong S, Hong KK, Govender P, Torreggiani W (2013) Reducing risk of transjugular intrahepatic portosystemic shunt using ultrasound guided single needle pass. World J Gastroenterol 19:3528–3530

    Article  PubMed  PubMed Central  Google Scholar 

  24. Delgado MG, Seijo S, Yepes I et al (2012) Efficacy and safety of anticoagulation on patients with cirrhosis and portal vein thrombosis. Clin Gastroenterol Hepatol 10:776–783

    Article  PubMed  Google Scholar 

  25. Chung JW, Kim GH, Lee JH et al (2014) Safety, efficacy, and response predictors of anticoagulation for the treatment of nonmalignant portal-vein thrombosis in patients with cirrhosis: a propensity score matching analysis. Clin Mol Hepatol 20:384–391

    Article  PubMed  PubMed Central  Google Scholar 

  26. Chen H, Liu L, Qi X et al (2016) Efficacy and safety of anticoagulation in more advanced portal vein thrombosis in patients with liver cirrhosis. Eur J Gastroenterol Hepatol 28:82–89

    Article  PubMed  CAS  Google Scholar 

  27. Wang Z, Jiang MS, Zhang HL et al (2016) Is post-TIPS anticoagulation therapy necessary in patients with cirrhosis and portal vein thrombosis? A randomized controlled trial. Radiology 279:943–951

    Article  PubMed  Google Scholar 

  28. Boyer TD, Haskal ZJ (2010) The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension. Hepatology 51:386–400

    Google Scholar 

  29. Krajina A, Hulek P, Fejfar T, Valek V (2012) Quality improvement guidelines for transjugular intrahepatic portosystemic shunt (TIPS). Cardiovasc Interv Radiol 35:1295–1300

    Article  Google Scholar 

  30. Qi X, Han G (2012) Transjugular intrahepatic portosystemic shunt in the treatment of portal vein thrombosis: a critical review of literature. Hepatol Int 6:576–590

    Article  PubMed  Google Scholar 

Download references

Funding

This study has received funding from the Science and Technology Planning Project of Guangdong Province, China, No. 2012B031800085.

Author information

Authors and Affiliations

  1. Department of Interventional Radiology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China

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

  2. Department of Radiology, Yuebei People’s Hospital, Shaoguan, 512026, China

    Youyong Zhang

Authors
  1. Junyang Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mingan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Youyong Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Haofan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mingsheng Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zhengran Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Junwei Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chun Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jiesheng Qian
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Shouhai Guan
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Zaibo Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zaibo Jiang.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Zaibo Jiang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Study subjects or cohorts overlap

Some study subjects (including one overlap patient) were previously reported by Li MA et al. (Zhonghua Yi Xue Za Zhi 92:2913-2917, 2012).

Methodology

• retrospective

• performed at one institution

Additional information

Junyang Luo and Mingan Li share first authorship.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Luo, J., Li, M., Zhang, Y. et al. Percutaneous transhepatic intrahepatic portosystemic shunt for variceal bleeding with chronic portal vein occlusion after splenectomy. Eur Radiol 28, 3661–3668 (2018). https://doi.org/10.1007/s00330-018-5360-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-018-5360-z

Keywords

Search

Navigation