Randomized Controlled Trial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2017; 23(41): 7470-7477
Published online Nov 7, 2017. doi: 10.3748/wjg.v23.i41.7470
Clinical outcomes of transcatheter selective superior mesenteric artery urokinase infusion therapy vs transjugular intrahepatic portosystemic shunt in patients with cirrhosis and acute portal vein thrombosis
Ting-Ting Jiang, Xiao-Ping Luo, Jian-Ming Sun, Jian Gao
Ting-Ting Jiang, Jian Gao, Department of Gastroenterology and Hepatology, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
Xiao-Ping Luo, Department of Radiology, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
Jian-Ming Sun, Department of Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
Author contributions: Jiang TT and Gao J designed the research; Jiang TT, Luo XP, and Sun JM performed the research and participated in data acquisition and analysis; Jiang TT wrote the paper.
Supported by the National Natural Science Foundation of China, No. 81572888.
Institutional review board statement: The study was reviewed and approved by the ethics committee of the Second Affiliated Hospital of Chongqing Medical University (Number: 2012-076).
Informed consent statement: All study participants provided written informed consent prior to study enrollment.
Conflict-of-interest statement: None declared.
Data sharing statement: None declared.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jian Gao, PhD, Professor, Chief, Department of Gastroenterology and Hepatology, Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing 400010, China. ykdxdeyy@public.cta.cq.cn
Telephone: +86-23-63693325 Fax: +86-23-63693323
Received: July 23, 2017
Peer-review started: July 25, 2017
First decision: August 30, 2017
Revised: September 10, 2017
Accepted: September 29, 2017
Article in press: September 28, 2017
Published online: November 7, 2017
Abstract
AIM

To compare the outcomes of transcatheter superior mesenteric artery (SMA) urokinase infusion and transjugular intrahepatic portosystemic shunt (TIPS) for acute portal vein thrombosis (PVT) in cirrhosis.

METHODS

From January 2013 to December 2014, patients with liver cirrhosis and acute symptomatic PVT who met the inclusion criteria were randomly assigned to either an SMA group or a TIPS group. The two groups accepted transcatheter selective SMA urokinase infusion therapy and TIPS, respectively. The total follow-up time was 24 mo. The primary outcome measure was the change in portal vein patency status which was evaluated by angio-computed tomography or Doppler ultrasound. Secondary outcomes were rebleeding and hepatic encephalopathy.

RESULTS

A total of 40 patients were enrolled, with 20 assigned to the SMA group and 20 to the TIPS group. The symptoms of all patients in the two groups improved within 48 h. PVT was improved in 17 (85%) patients in the SMA group and 14 (70%) patients in the TIPS group. The main portal vein (MPV) thrombosis was significantly reduced in both groups (P < 0.001), and there was no significant difference between them (P = 0.304). In the SMA group, superior mesenteric vein (SMV) thrombosis and splenic vein (SV) thrombosis were significantly reduced (P = 0.048 and P = 0.02), which did not occur in the TIPS group. At 6-, 12-, and 24-mo follow-up, in the SMA group and the TIPS group, the cumulative rates free of the first episode of rebleeding were 80%, 65%, and 45% vs 90%, 80%, and 60%, respectively (P = 0.320); the cumulative rates free of the first episode of hepatic encephalopathy were 85%, 80%, and 65% vs 50%, 40%, and 35%, respectively (P = 0.022).

CONCLUSION

Transcatheter selective SMA urokinase infusion and TIPS are safe and effective for acute symptomatic PVT in cirrhosis.

Keywords: Cirrhosis, Portal vein thrombosis, Superior mesenteric artery, Urokinase, Transjugular intrahepatic portosystemic shunt

Core tip: Transcatheter selective superior mesenteric artery urokinase infusion therapy and transjugular intrahepatic portosystemic shunt can both significantly reduce acute portal vein thrombosis in cirrhosis, and there was no significant difference between them. Moreover, the two strategies did not result in serious adverse events such as bleeding.