Acute Portal Vein Thrombosis, No Longer a Contraindication for Transjugular Intrahepatic Porto-Systemic Shunt (TIPS) Insertion

Mammen, Suraj; Keshava, Shyamkumar N.; Kattiparambil, Sajith

doi:10.1016/j.jceh.2014.08.008

Cited by 7 publications

(5 citation statements)

References 8 publications

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“…Portal vein thrombosis, once considered a contraindication for TIPS, has indeed become an ""indication"" in the setting of cirrhotic and non-cirrhotic cases 18,30,31 . The potential concerns in performing TIPS in a patient with acute portal vein thrombosis would be increased technical difficulty in performing the procedure as their blood cannot be freely aspirated from the portal vein after the puncture, a gradient across the stent cannot always be established, and the risk for pulmonary embolism when portal venous thrombolysis is done through TIPS tract.…”

Section: Discussionmentioning

confidence: 99%

Conservative short-term treatment of non-cirrhotic non-malignant portal vein thrombosis

et al. 2023

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Introduction. Portal vein (PV) thrombosis (PVT) is a partial or a complete obstruction of blood flow as a result of a thrombus mass in the lumen of PV. In the acute phase, the symptoms are unspecific such as right upper quadrant pain, nausea and fever. Diversity of subacute and chronic symptoms are associated with complications related to PVT and portal hypertension. Case report. We are presenting a case of a 50-year-old female who was admitted in hospital due to acute abdominal cramping pain. The pain lasted for 15 to 20 minutes, and was followed by defecation of normal stool and haematochezia in three occasions. The abdominal pain returned in several hours, again followed by haematochezia and tenesmuses every 10 minutes. After admission a colonoscopy was performed that determined vulnerable, erythematous mucosa of the colon with contact bleeding from lienal flexure to rectosigmoid junction. During the colonoscopy, a biopsy was performed. A computer tomography (CT) scan revealed partial PVT, thrombosis of intrahepatic branches of PV and thrombosis of the inferior mesenteric vein. After conservative treatment with low molecular weight heparin (LWMH), and other supportive measures the digestive bleeding ceased, and defecation became normal. During one month follow up a patient has had no complications and control CT scan revealed normal PV flow without thrombosis. Conclusion: Although is a rare, a non-malignant and non-cirrhotic PVT in differential diagnosis should not be neglected because timely and vigilant therapy with LWMH can lead to complete resolution without serious complication.

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Section: Discussionmentioning

confidence: 99%

Conservative short-term treatment of non-cirrhotic non-malignant portal vein thrombosis

et al. 2023

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“…The details of TIPS procedure in patients with acute portal vein thrombosis have been previously described. 10 After placement of the stent, suction thrombectomy and thrombolysis were performed to relieve the portal vein thrombus. If TIPS was performed during pregnancy, extreme care was taken to restrict the radiation, for inevitable indications.…”

Section: Methodsmentioning

confidence: 99%

“…Among the BCS patients, 86 of the 91 cases (95%) had refractory ascites, while five (5%) had variceal bleeding. In patients with BCS, the median BCS TIPS prognostic index was 3.7 (1.1-6.5) and the median MELD score was 12 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). The indication for TIPS in patients with VOD was refractory ascites; the patient with CPSS was asymptomatic but underwent prophylactic TIPS prior to the closure of the shunt.…”

Section: Demographicsmentioning

confidence: 99%

Technical and Medium-Term Clinical Outcomes of Transjugular Intrahepatic Portosystemic Shunt with Fluoroscopy and Additional Trans-abdominal Ultrasound Guidance

Keshava

Moses

Sharma

et al. 2021

Indian J Radiol Imaging

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Background and Objective The aim of the study is to evaluate the technical and clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) performed with additional transabdominal ultrasound guidance. Material and Methods Patients who underwent TIPS between January 2004 to January 2020 in our center were studied. Technical, hemodynamic, angiographic, and clinical outcome were recorded up to 1 year of follow-up. Results TIPS was attempted in 162 patients (median [range] age 37[3–69] years; 105 were males and 57 were females; Etiology: Budd-Chiari syndrome [BCS] 91, cirrhosis 65, symptomatic acute portal venous thrombosis [PVT] 3, veno-occlusive disease [VOD] 2, congenital portosystemic shunt [CPSS] 1) during the study period. Indication for TIPS was refractory ascites in 135 patients (BCS 86, cirrhosis 49) and variceal bleed in 21 patients (BCS 5, cirrhosis 16). Technical success was seen in 161 of the 162 (99.4%) patients. The tract was created from hepatic vein in 55 patients and inferior vena cava (IVC) in 106 patients. Complications within 1 week post TIPS were seen in 29 of the 162 (18%) patients, of whom one developed unexplained arrhythmia and hypotension and died. Of the patients with available follow-up, clinical success was noted in 120 (81%), while 14 (9%) patients had partial nonresponse and six (4%) had complete nonresponse. Eight (5%) patients died during the follow-up period. Conclusion The technical success of TIPS creation with additional transabdominal ultrasound guidance is very high with low peri-procedural complication rate. It has enabled the inclusion of a wider spectrum of cases like acute PVT and obliterated hepatic veins which were otherwise considered contraindications.

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“…Patients with refractory ascites should be evaluated for liver transplantation as it may offer the best chance for long-term survival and improved quality of life. All patients with ascites should be considered as potential candidates for liver transplantation to optimize their outcomes [30][31][32][33].…”

Section: Transjugular Intrahepatic Portalmentioning

confidence: 99%

Ascities after Liver Cirrhosis Diagnosis and Treatment

Mahmood,

Zhayier,

Shoaib

2024

J Sur Anesth Res, 2024

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Ascites, the accumulation of fluid in the abdominal cavity, is a common complication in patients with cirrhosis. Approximately 50% of patients with compensated cirrhosis will develop ascites over a 10-year period, marking a significant milestone in the progression of end-stage liver disease. Survival rates decrease after the onset of ascites, with only 50% of patients surviving 2 to 5 years, depending on the underlying cause of cirrhosis, The management of ascites involves salt restriction and diuretic use, which are effective in about 90% of patients in reducing fluid accumulation and symptoms. In cases where ascites does not respond to these measures, additional interventions such as large-volume paracentesis may be necessary as a temporary solution or for symptomatic relief while awaiting liver transplantation, for patients with refractory ascites, the transjugular intrahepatic portosystemic shunt (TIPS) procedure can be considered. This involves creating a shunt between the portal vein and hepatic vein to reduce portal hypertension. TIPS can serve as a bridge to liver transplantation or provide long-term palliation, but careful monitoring for bacterial peritonitis is essential. Patients at high risk for bacterial peritonitis should receive antibiotic prophylaxis to prevent this serious infection. Prompt diagnostic paracentesis is necessary when spontaneous bacterial peritonitis is suspected, involving the removal and analysis of fluid from the abdominal cavity

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Acute Portal Vein Thrombosis, No Longer a Contraindication for Transjugular Intrahepatic Porto-Systemic Shunt (TIPS) Insertion

Cited by 7 publications

References 8 publications

Conservative short-term treatment of non-cirrhotic non-malignant portal vein thrombosis

Conservative short-term treatment of non-cirrhotic non-malignant portal vein thrombosis

Technical and Medium-Term Clinical Outcomes of Transjugular Intrahepatic Portosystemic Shunt with Fluoroscopy and Additional Trans-abdominal Ultrasound Guidance

Ascities after Liver Cirrhosis Diagnosis and Treatment

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