Published online Sep 6, 2019. doi: 10.12998/wjcc.v7.i17.2450
Peer-review started: April 15, 2019
First decision: May 31, 2019
Revised: July 11, 2019
Accepted: July 20, 2019
Article in press: July 20, 2019
Published online: September 6, 2019
Transjugular intrahepatic portosystemic shunt (TIPS) is widely accepted as an alternative to surgery for management of complications of portal hypertension. TIPS has been used to treat portal vein thrombosis (PVT) in many centers since the 1990s. Although TIPS has good therapeutic effects on the formation of PVT, the effect of PVT on TIPS stenting has rarely been reported. Patients with splenectomy and pericardial devascu-larization have a high incidence of PVT, which can markedly affect TIPS stent patency and increase the risk of recurrent symptoms associated with shunt stenosis or occlusion.
To investigate the incidence of PVT after splenectomy and its influence on the patency rate of TIPS in patients with cirrhosis and portal hypertension.
Four hundred and eighty-six patients with portal hypertension for refractory ascites and/or variceal bleeding who required TIPS placement between January 2010 and January 2016 were included in this retrospective analysis. Patients without prior splenectomy were defined as group A (n = 289) and those with prior splenectomy as group B (n = 197). The incidence of PVT before TIPS was compared between the two groups. After TIPS placement, primary patency rate was compared using Kaplan–Meier analysis at 3, 6, 9 and 12 mo, and 2 and 3 years. The clinical outcomes were analyzed.
Before TIPS procedure, the incidence of PVT in group A was lower than in group B (P = 0.003), and TIPS technical success rate in group A was higher than in group B (P = 0.016). The primary patency rate in group A tended to be higher than in group B at 3, 6, 9 and 12 mo, 2 years and 3 years (P = 0.006, P = 0.011, P = 0.023, P = 0.032, P = 0.037 and P = 0.028, respectively). Recurrence of bleeding and ascites rate in group A was lower than in group B at 3 mo (P ≤ 0.001 and P = 0.001), 6 mo (P = 0.003 and P = 0.005), 9 mo (P = 0.005 and P = 0.012), 12 mo (P = 0.008 and P = 0.024), 2 years (P = 0.011 and P = 0.018) and 3 years (P = 0.016 and P = 0.017), respectively. During 3-years follow-up, the 1-, 2- and 3-year survival rate in group A were higher than in group B (P = 0.008, P = 0.021, P = 0.018, respectively), but there was no difference of the incidence of hepatic encephalopathy (P = 0.527).
Patients with prior splenectomy have a high incidence of PVT, which potentially increases the risk of recurrent symptoms associated with shunt stenosis or occlusion.
Core tip: There are several approaches for treatment of portal hypertension related varices and variceal hemorrhage, including drugs, endoscopic variceal ligation, transjugular intrahepatic portosystemic shunt, splenectomy with pericardial devascularization and liver transplantation. Transjugular intrahepatic portosystemic shunt is widely accepted as an alternative to surgery for management of complications of portal hypertension such as variceal bleeding, refractory ascites, Budd–Chiari syndrome, hepatorenal syndrome, hepatic hydrothorax and even hepatopulmonary syndrome. Patients with splenectomy with pericardial devascularization had a high incidence of portal vein thrombosis, which can markedly affect transjugular intrahepatic portosystemic shunt stent patency and potentially increase the risk of recurrent symptoms associated with shunt stenosis or occlusion.