Use of Transjugular Intrahepatic Portosystemic Shunts during Lytic Therapy of Extensive Portal Splenic and Mesenteric Venous Thrombosis: Long-term Follow-up

Non‐cavernomatous superior mesenteric thrombosis successfully recanalized with interventional radiological procedures carried out with a combination transmesenteric and transjugular approaches

“…When those conditions are not satisfied, stenting in the TIPS tract might be recommended. One of four different approach routes to carry out interventional radiological procedures for an obstructed segment may be selected, that is, transjugular, 1,5,6 transhepatic, 2,3 transsplenic 7 and transmesenteric 4 . Treatments reported to recanalize an obstructed segment are catheter‐directed thrombolysis, 1,4–6 dilation with an angioplasty balloon catheter, 2,3,5,6 mechanical 4–6 or aspiration thrombectomy 5 and stent implantation 2–4 …”

“…The second important purpose of implanting a stent in the TIPS tract is simply to allow the TIPS tract to be used as an approach route for subsequent relief of an obstruction. When TIPS is used for this purpose, TIPS creation with stent implantation is carried out as the initial procedure, then interventional radiological treatments are carried out by advancing devices through this route 1,5,6 . Of course, even when used for this purpose, stenting in the TIPS tract would play a role in achieving sufficient outflow.…”

“…Although the placement of a transjugular intrahepatic portosystemic venous shunt (TIPS) has been widely accepted as an effective treatment for chronic gastrointestinal varices caused by portal hypertension, obstruction of the portal venous system has been considered an indication in relatively few cases or institutions 1 . However, the number of studies of TIPS for portal hypertension even with portal venous thrombosis, although few, has been increasing 1–7 …”

Acute Mesenteric Ischemia

“…Systemic intravenous tPA has been successfully reported [77]. Trans-jugular intrahepatic portosystemic shunt can be used for MVT with the rationale of decreasing portal pressure, which works as a vacuum of clot fragments and improves the effectiveness of thrombolysis in the case of acute thrombosis [78][79][80].…”

Mesenteric Venous Thrombosis

“…39 Two cases, one with extensive portal, mesenteric and splenic vein thrombosis and another with mesenteric and portal vein thrombosis have been reported to have favorable outcomes with TIPS. 40 A retrospective study on 20 patients with portal vein thrombosis (PVT) suggested a high success rate in cases of non-cavernous PVT and it was effective in prevention of variceal bleeding and recurrent ascites. 41 Another prospective analysis of 9 patients with PVT reported a complication rate of up to 22% with 11% mortality.…”