Transsplenic Portal Vein Recanalization followed by TIPS in Chronic Portal Vein Thrombosis: A Retrospective Cohort Study

Introduction Portal vein recanalization via a trans-splenic access followed by transjugular intrahepatic portosystemic shunt (PVR-TIPS) has emerged as a therapeutic option for patients with chronic portal vein thrombosis (PVT) and complications such as recurrent variceal bleeding or refractory ascites which are not manageable by medical or endoscopic means. This study aims to evaluate the feasibility, safety, and efficacy of PVR-TIPS in patients with chronic PVT.

Material and Methods We retrospectively analyzed patients who underwent PVR-TIPS for chronic portal vein thrombosis between 2019 and 2024 at the University Hospital Innsbruck. Demographic, clinical, and laboratory data were obtained from electronic health records.

Results In thirty patients (mean age 56.7 years) a PVR-TIPS was attempted at our center. The most common underlying etiologies were myeloproliferative neoplasms (36.7%), cirrhosis (23.3%), and postsurgical complications (10%). Indications for PVR-TIPS included uncontrolled variceal bleeding (76.7%) and refractory ascites (36.7%). Technical success was achieved in 24 patients (80%). In eight cases, a novel "bottoms-up" retrograde puncture technique from the right hepatic vein was employed. At follow-up, TIPS patency was maintained in 80% of patients, with associated clinical improvements including resolution or reduction of varices in 75% and ascites in 55%. Recurrent variceal bleeding occurred in 13% of patients after PVR-TIPS. Procedure-related complications included non-variceal bleeding (43.3%), thrombosis (30%), fever (30%), and hepatic encephalopathy (6.7%). One patient died due to intraprocedural bleeding. Overall survival was 80% with a median follow-up of 12.1 months.

Conclusion PVR-TIPS can be an effective therapeutic approach in selected patients with complications due to chronic PVT. At our center, high rates of technical success and clinical improvement were achieved. However, the considerable complication rate highlights the need for careful patient selection, procedural expertise, and close post-procedural care.

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Artikel online veröffentlicht:
13. Mai 2025