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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 6
Jun.  2021
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Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(6): 1331-1335

Value of transjugular intrahepatic portosystemic shunt in the prevention of esophageal variceal rebleeding in patients with portal vein thrombosis after splenectomy

DOI: 10.3969/j.issn.1001-5256.2021.06.023
  • 1.

    Department of Interventional Radiography, Qingdao Municipal Hospital, Qingdao, Shandong 266011, China

  • 2.

    Department of Gastroenterology, Shandong Provincial Hospital, Jinan 250021, China

  • Received Date: 2020-10-28
  • Accepted Date: 2020-12-16
  • Published Date: 2021-06-20
    Abstract
  •   Objective  To investigate the technical success rate and outcome of transjugular intrahepatic portosystemic shunt (TIPS) in preventing esophageal variceal rebleeding in patients with portal vein thrombosis (PVT) after splenectomy.  Methods  A retrospective analysis was performed for the clinical data of 46 patients with PVT after splenectomy who were admitted to Shandong Provincial Hospital from December 2009 to January 2017 and underwent TIPS to prevent esophageal variceal rebleeding. According to the success or failure of TIPS, the patients were divided into TIPS success group with 38 patients and TIPS failure group with 8 patients. The two groups were compared in terms of postoperative variceal rebleeding, stent dysfunction, hepatic encephalopathy (HE), and survival. The paired t-test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier curve was used to analyze variceal rebleeding-free rate, stent patency rate, HE-free rate, and survival rate, and the log-rank test was used for comparison of cumulative rebleeding-free rate and cumulative survival rate.  Results  The technical success rate of TIPS was 82.6%. There were significant differences in 6-, 12-, and 24-month cumulative rebleeding-free rates between the TIPS success group and the TIPS failure group (94.3%/89.8%/89.8% vs 85.7%/85.7%/28.6%, χ2=4.563, P=0.033). In the TIPS success group, the 6-, 12-, and 24-month cumulative stent patency rates were 79.3%, 74.3%, and 69.0%, respectively, and the 6-, 12-, and 24-month cumulative HE-free rates after TIPS were 72.1%, 55.5%, and 55.5%, respectively. There were significant differences in 6-, 12-, and 24-month cumulative survival rates between the TIPS success group and the TIPS failure group (94.0%/94.0%/86.2% vs 71.4%/71.4%/71.4%, χ2=4.988, P=0.026).  Conclusion  TIPS is a safe and feasible method for preventing esophageal variceal rebleeding in patients with PVT after splenectomy, and TIPS combined with a percutaneous transhepatic approach may promote technical success.

     

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    • References(21)
  • [1]
    LUO J, LI M, ZHANG Y, et al. Percutaneous transhepatic intrahepatic portosystemic shunt for variceal bleeding with chronic portal vein occlusion after splenectomy[J]. Eur Radiol, 2018, 28(9): 3661-3668. DOI: 10.1007/s00330-018-5360-z.
    [2]
    MAKDISSI FF, HERMAN P, MACHADO MA, et al. Portal vein thrombosis after esophagogastric devascularization and splenectomy in schistosomal portal hypertension patients: What's the real importance?[J]. Arq Gastroenterol, 2009, 46(1): 50-56. DOI: 10.1590/s0004-28032009000100014.
    [3]
    DANNO K, IKEDA M, SEKIMOTO M, et al. Diameter of splenic vein is a risk factor for portal or splenic vein thrombosis after laparoscopic splenectomy[J]. Surgery, 2009, 145(5): 457-464; discussion 465-466. DOI: 10.1016/j.surg.2008.06.030.
    [4]
    IKEDA M, SEKIMOTO M, TAKIGUCHI S, et al. High incidence of thrombosis of the portal venous system after laparoscopic splenectomy: A prospective study with contrast-enhanced CT scan[J]. Ann Surg, 2005, 241(2): 208-216. DOI: 10.1097/01.sla.0000151794.28392.a6.
    [5]
    HE S, HE F. Predictive model of portal venous system thrombosis in cirrhotic portal hypertensive patients after splenectomy[J]. Int J Clin Exp Med, 2015, 8(3): 4236-4242.
    [6]
    DIAO YP, YANG N, GUO LL, et al. Unconventional interventional therapy for cavernous transformation of the portal vein[J]. Ann Vasc Surg, 2014, 28(7): 1791. e9-1791. e11. DOI: 10.1016/j.avsg.2014.03.005.
    [7]
    SENZOLO M, TIBBALS J, CHOLONGITAS E, et al. Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with and without cavernous transformation[J]. Aliment Pharmacol Ther, 2006, 23(6): 767-775. DOI: 10.1111/j.1365-2036.2006.02820.x.
    [8]
    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[J]. Gut, 2011, 60(6): 846-852. DOI: 10.1136/gut.2010.228023.
    [9]
    RADOSEVICH PM, RING EJ, LABERGE JM, et al. Transjugular intrahepatic portosystemic shunts in patients with portal vein occlusion[J]. Radiology, 1993, 186(2): 523-527. DOI: 10.1148/radiology.186.2.8421759.
    [10]
    LUO X, WANG Z, TSAUO J, et al. Advanced cirrhosis combined with portal vein thrombosis: A randomized trial of TIPS versus endoscopic band ligation plus propranolol for the prevention of recurrent esophageal variceal bleeding[J]. Radiology, 2015, 276(1): 286-293. DOI: 10.1148/radiol.15141252.
    [11]
    FANELLI F, ANGELONI S, SALVATORI FM, et al. Transjugular intrahepatic portosystemic shunt with expanded-polytetrafuoroethylene-covered stents in non-cirrhotic patients with portal cavernoma[J]. Dig Liver Dis, 2011, 43(1): 78-84. DOI: 10.1016/j.dld.2010.06.001.
    [12]
    QI X, HAN G, YE C, et al. Splenectomy causes 10-fold increased risk of portal venous system thrombosis in liver cirrhosis patients[J]. Med Sci Monit, 2016, 22: 2528-2550. DOI: 10.12659/msm.898866.
    [13]
    WANG MQ, LIN HY, GUO LP, et al. Acute extensive portal and mesenteric venous thrombosis after splenectomy: Treated by interventional thrombolysis with transjugular approach[J]. World J Gastroenterol, 2009, 15(24): 3038-3045. DOI: 10.3748/wjg.15.3038.
    [14]
    QI X, BAI M, GUO X, et al. Pharmacologic prophylaxis of portal venous system thrombosis after splenectomy: A meta-analysis[J]. Gastroenterol Res Pract, 2014, 2014: 292689. DOI: 10.1155/2014/292689.
    [15]
    SONG B, MIN P, OUDKERK M, et al. Cavernous transformation of the portal vein secondary to tumor thrombosis of hepatocellular carcinoma: Spiral CT visualization of the collateral vessels[J]. Abdom Imaging, 2000, 25(4): 385-393. DOI: 10.1007/s002610000057.
    [16]
    KINJO N, KAWANAKA H, AKAHOSHI T, et al. Risk factors for portal venous thrombosis after splenectomy in patients with cirrhosis and portal hypertension[J]. Br J Surg, 2010, 97(6): 910-916. DOI: 10.1002/bjs.7002.
    [17]
    LUO X, NIE L, ZHOU B, et al. Transjugular intrahepatic portosystemic shunt for the treatment of portal hypertension in noncirrhotic patients with portal cavernoma[J]. Gastroenterol Res Pract, 2014, 2014: 659726. DOI: 10.1155/2014/659726.
    [18]
    HAN G, QI X, HE C, et al. Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with symptomatic portal hypertension in liver cirrhosis[J]. J Hepatol, 2011, 54(1): 78-88. DOI: 10.1016/j.jhep.2010.06.029.
    [19]
    DONG F, LUO SH, ZHENG LJ, et al. Incidence of portal vein thrombosis after splenectomy and its influence on transjugular intrahepatic portosystemic shunt stent patency[J]. World J Clin Cases, 2019, 7(17): 2450-2462. DOI: 10.12998/wjcc.v7.i17.2450.
    [20]
    WANG L, HE F, YUE Z, et al. Techniques and long-term effects of transjugular intrahepatic portosystemic shunt on liver cirrhosis-related thrombotic total occlusion of main portal vein[J]. Sci Rep, 2017, 7(1): 10868. DOI: 10.1038/s41598-017-11455-y.
    [21]
    STAMOU KM, TOUTOUZAS KG, KEKIS PB, et al. Prospective study of the incidence and risk factors of postsplenectomy thrombosis of the portal, mesenteric, and splenic veins[J]. Arch Surg, 2006, 141(7): 663-669. DOI: 10.1001/archsurg.141.7.663.
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