Abstract
BACKGROUND & AIMS: Anticoagulation is considered the standard of care for portal vein thrombosis (PVT) in cirrhosis; however, a significant number of patients cannot be safely treated or exhibit thrombus progression despite anticoagulation. We evaluated the role of transjugular intrahepatic portosystemic shunt (TIPS) when indicated exclusively as treatment of PVT in cirrhosis. METHODS: A retrospective study was conducted including all cirrhotic patients with nontumoral PVT treated with TIPS in a tertiary care center. Patients with PVT and additional indications for TIPS were excluded. Feasibility, safety, and efficacy were analyzed. TIPS outcomes compared with a contemporary cohort of patients with TIPS indicated for refractory ascites. RESULTS: A total of 243 patients were treated by TIPS during the study period, 30 of whom underwent the procedure solely to achieve portal vein recanalization. Portal cavernoma was present in 40% of patients, and 53% of the patients had Yerdel 3 or 4 PVT. Main indications for TIPS were contraindication (53%) or a lack of response (30%) to anticoagulant therapy. In 17% of cases, TIPS was indicated to facilitate liver transplantation (LT) when PVT precluded portal anastomosis. TIPS was successful in 96.6% of patients. Major complications (2 patients) and shunt-related events after TIPS were similar to those reported in the control group. Seventeen percent of patients showed TIPS dysfunction (all successfully treated), a rate similar to that reported in patients with refractory ascites. A higher post-TIPS portacaval pressure gradient was associated with a greater risk of dysfunction. The main portal vein trunk remained patent in all patients, 8 of whom received uneventful LT. CONCLUSION: TIPS can be safely performed in patients with cirrhosis and PVT, with an indication for recanalization if medical therapy has failed or is contraindicated.