Transjugular intrahepatic portosystemic shunt with covered stents for hepatocellular carcinoma with portal vein tumor thrombosis

Table 1 Clinical data of the 11 patients

Case No.	Age (yr)	Localization of tumor	Localization of portal vein tumor thrombus	Treatment before TIPS	Eextrahepatic metastasis	Symptoms before TIPS	Gastroscopic findings before TIPS	Child-Pugh score
1	59	S2, 3, 4	Main, left branch	TACE once	Metastasis in both lungs	Vomiting blood for 3 d	Severe varicosis	6
2	78	S5, 6	Main, both left and right branches	None	None	Massive refractory ascites for 3 mo	Not performed	8
3	41	S7, 8	Main, both left and right branches	TACE 3 times	Lymphatic metastasis in hepatic hilus and cardio- diaphragmatic angle	Vomiting blood for 5 d	Severe varicosis	6
4	66	S2, 3	Main, left branch	TACE twice, RF once	None	Massive refractory ascites for 6 mo	Not performed	7
5	37	S2, 3, 4, 7	Main, both left and right branches	None	Metastasis in both lungs	Vomiting blood for 5 d	Severe varicosis	7
6	46	S2, 3, 5, 6	Main, left branch	None	None	Vomiting blood for 6 d	Severe varicosis	6
7	43	S5, 6	Main, right branch	None	None	Vomiting blood for 3 d	Severe varicosis	5
8	55	S5, 6, 7	Main, both left and right branches	TACE 3 times, RF once	Metastasis in both lungs	Vomiting blood for 2 d	Severe varicosis	8
9	60	S2, 5, 6	Main, both left and right branches	TACE once	Metastasis in both lungs	Vomiting blood for 3 d	Severe varicosis	5
10	57	S2, 3, 4	Main, left branch	TACE 2 times	None	Vomiting blood for 7 d	Severe varicosis	5
11	55	S5, 8	Main, both left and right branches	TACE once, RF once	Metastasis in both lungs	Vomiting blood for 1 d	Severe varicosis	7

TIPS: Transjugular intrahepatic portosystemic shunt; TACE: Transcatheter arterial chemoembolization; RF: Radio frequency.

Table 2 Transjugular intrahepatic portosystemic shunt procedures and outcomes

Case No.	Covered stent (diameter × length mm)	Hepatic arterial angiography	PPG before TIPS (mmHg)	PPG after TIPS (mmHg)	Outcomes	Postoperative HE	Follow-up
1	8 × 40, 8 × 80	No obvious APF	33	10	Hemostasis	Grade II HE	Death after 4 mo
2	8 × 80, 8 × 60	No obvious APF	29	10	Cured ascites	Grade II HE	Death after 4 mo
3	8 × 80, 8 × 80	No obvious APF	36	12	Hemostasis	No	Death after 2 mo
4	7 × 80	Obvious APF	26	7	Alleviated ascites	No	Survived the 16 mo
5	8 × 80, 8 × 80	No obvious APF	37	19	Hemostasis	Grade I HE	Death after 2 mo
6	8 × 80, 8 × 60	No obvious APF	32	14	Hemostasis	Grade I HE	Death after 6 mo
7	8 × 80, 8 × 60	No obvious APF	27	12	Hemostasis	No	Death after 14 mo
8	8 × 80, 8 × 60	No obvious APF	37	13	Hemostasis	Grade III HE	Death after 3 mo
9	8 × 80, 8 × 80	No obvious APF	31	12	Hemostasis	No	Death after 10 mo
10	8 × 80, 8 × 60	No obvious APF	28	9	Hemostasis	No	Survived the 18 mo
11	8 × 80, 8 × 60	No obvious APF	36	12	Hemostasis	Grade II HE	Death after 6 mo

TIPS: Transjugular intrahepatic portosystemic shunt; PPG: Portosystemic pressure gradient; APF: Active power filter.

Table 3 Brief summary of published studies: Transjugular intrahepatic portosystemic shunt for malignant portal vein obstruction n (%)

Ref.	Type of paper	Technical success rate	Stent used in TIPS	Shunt dysfunction	Indication of TIPS	Localization of PVTT	Prognosis
Chung et al[17]	Case report	6 (100)	Bare stent	2 (33)	Recurrent variceal bleeding (n = 6)	Portal trunk (n = 6)	3 patients died at postoperative month 4
Wallace et al[18]	Case series	37 (97)	Bare stent	44%	Variceal hemorrhage (n = 16), BCS (n = 3), refractory ascites/hydrothorax (n = 14), other (n = 5)	Portal trunk (n = 6), right branch (n = 5), left branch (n = 2)	30- and 90-d survival rates were 84% and 60%, respectively
Jiang et al[19]	Case series	10 (71.4)	Bare stent	NA	Intractable ascites (n = 3), simple hemorrhage (n = 1), hemorrhage and ascites (n = 10)	Portal trunk (n = 14), right branch (n = 11), left branch (n = 4)	Mean survival time 132.3 d
Burger et al[20]	Case report	2 (100)	Bare stent	0%	Recurrent variceal bleeding (n = 1), refractory ascites (n = 1)	Portal trunk (n = 2)	One patient died at postoperative month 3

BCS: Budd-Chiari syndrome; NA: Not available; PVTT: Portal vein tumor thrombosis; TIPS: Transjugular intrahepatic portosystemic shunt.