The role of transjugular intrahepatic portosystemic shunt in the management of portal vein thrombosis: A systematic review and meta-analysis

Valentin, Nelson; Korrapati, Praneet; Constantino, J.; Young, Archie; Weisberg, Ilan

doi:10.1016/s0168-8278(18)31706-9

Cited by 7 publications

(7 citation statements)

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“…Valentin et al reported a high feasibility and recanalisation of PVT with TIPSS using a meta‐analytic approach . However, no data regarding complications and possible factors impacting relevant outcomes have been studied.…”

Section: Discussionmentioning

confidence: 99%

Systematic review with meta‐analysis: portal vein recanalisation and transjugular intrahepatic portosystemic shunt for portal vein thrombosis

Rodrigues

Sixt

Abraldes

et al. 2018

Aliment Pharmacol Ther

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Summary Background Transjugular intrahepatic portosystemic shunt has been increasingly used in patients with portal vein thrombosis to obtain patency, but evidenced‐based decisions are challenging. Aim To evaluate published data on efficacy and safety of endovascular therapy in portal vein thrombosis. Methods Systematic search of PubMed, ISI, Scopus, and Embase for studies (in English, until October 2017) reporting feasibility, safety, 12‐month portal vein recanalisation, transjugular intrahepatic portosystemic shunt patency, and survival in patients with benign portal vein thrombosis undergoing endovascular treatment. An independent extraction of articles using predefined data fields and quality indicators was used; pooled analyses based on random‐effects models; heterogeneity assessment by Cochran's Q, I2 statistic, subgroup analyses, and meta‐regression. Results Thirteen studies including 399 patients (92% cirrhosis; portal vein thrombosis: complete 46%, chronic 87%, cavernous transformation 17%, superior mesenteric vein involvement 55%) were included. Transjugular intrahepatic portosystemic shunt was technically feasible in 95% (95% CI: 89%‐98%) with heterogeneity (I2 = 57%, P < 0.001) explained by cavernous transformation. Major complications occurred in 10% (95% CI: 6.0%‐18.0%; I2 = 52%, P = 0.55). Additional catheter‐directed thrombolysis was associated with more complications compared to transjugular intrahepatic portosystemic shunt alone or plus thrombectomy (17.6% vs 3.3%). Twelve‐month portal vein recanalisation was 79% (95% CI: 67%‐88%; I2 = 78%, P < 0.01). Shunt patency at 12 months was 84% (95% CI: 76%‐90%; I2 = 62%, P < 0.01). Overall 12‐month survival rate was 89%, with no heterogeneity. Conclusions Transjugular intrahepatic portosystemic shunt for portal vein thrombosis recanalisation was highly feasible, effective, and safe. Cavernous transformation was the main determinant of technical failure. Additional catheter‐directed thrombolysis was associated with higher risk of severe complications.

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Section: Discussionmentioning

confidence: 99%

Systematic review with meta‐analysis: portal vein recanalisation and transjugular intrahepatic portosystemic shunt for portal vein thrombosis

Rodrigues

Sixt

Abraldes

et al. 2018

Aliment Pharmacol Ther

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“…A meta-analysis identified a 60%–99% technical success rate (pooled 86%), and likely reflects a significant reporting bias, with a 25% incidence of hepatic encephalopathy 127. Another systematic review reported similar findings, although heterogeneity was noted due to cavernous transformation 128.…”

Section: Indications For Tipssmentioning

confidence: 94%

Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension

Tripathi

Stanley

Hayes

et al. 2020

Gut

231

220

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These guidelines on transjugular intrahepatic portosystemic stent-shunt (TIPSS) in the management of portal hypertension have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the Liver Section of the BSG. The guidelines are new and have been produced in collaboration with the British Society of Interventional Radiology (BSIR) and British Association of the Study of the Liver (BASL). The guidelines development group comprises elected members of the BSG Liver Section, representation from BASL, a nursing representative and two patient representatives. The quality of evidence and grading of recommendations was appraised using the GRADE system. These guidelines are aimed at healthcare professionals considering referring a patient for a TIPSS. They comprise the following subheadings: indications; patient selection; procedural details; complications; and research agenda. They are not designed to address: the management of the underlying liver disease; the role of TIPSS in children; or complex technical and procedural aspects of TIPSS.

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“…Although most studies describing TIPS‐PVR have involved patients with cirrhosis, some patients without cirrhosis have also been studied. ( 153 ) Some studies show good results performing PVR without the need for TIPS provided the PVT does not occlude the distal intrahepatic PV branches. ( 154,155 ) More data are needed about the potential utility of TIPS‐PVR in patients with chronic PVT.…”

Section: Pvt Treatment Optionsmentioning

confidence: 99%

Vascular Liver Disorders, Portal Vein Thrombosis, and Procedural Bleeding in Patients With Liver Disease: 2020 Practice Guidance by the American Association for the Study of Liver Diseases

et al. 2021

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The role of transjugular intrahepatic portosystemic shunt in the management of portal vein thrombosis: A systematic review and meta-analysis

Cited by 7 publications

References 0 publications

Systematic review with meta‐analysis: portal vein recanalisation and transjugular intrahepatic portosystemic shunt for portal vein thrombosis

Systematic review with meta‐analysis: portal vein recanalisation and transjugular intrahepatic portosystemic shunt for portal vein thrombosis

Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension

Vascular Liver Disorders, Portal Vein Thrombosis, and Procedural Bleeding in Patients With Liver Disease: 2020 Practice Guidance by the American Association for the Study of Liver Diseases

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