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SIR 2025

Venous Interventions

Scientific Session

Session: Portal Hypertension 3

Incidence and Clinical Outcomes in Cirrhotic Patients with PVT who undergo TIPS-PVR (Portal Vein Recanalization)

Wednesday, April 2, 2025
11:06 AM – 11:15 AM CT
Location: Music City Center, 208 AB
Purpose: To evaluate the safety and outcomes of portal vein recanalization and transjugular intrahepatic portosystemic shunt (PVR-TIPS) in cirrhotic patients with portal vein thrombosis (PVT).

Materials and Methods: A retrospective review was conducted of all cirrhotic patients with PVT who underwent PVR-TIPS between 2000 and 2024 at a single academic center. Demographic data and etiologies of PVT were acquired. The degree of thrombosis was analyzed based on the American Association for the Study of Liver Diseases (AASLD) guidelines. Technical success, one-year patency rates, and patient outcomes were recorded over a one-year follow-up period.

Results: There were 73 patients (82% male) with a mean age of 59 ± 9.2 years who underwent TIPS-PVR. Causes of PVT included portal hypertension secondary to cirrhosis (45%), idiopathic (34%), and hypercoagulable states (10 %). TIPS-PVR was technically successful in 72 patients (99 %).
Most patients 51 (70 %) showed a progression of PVT prior to TIPS-PVR. On evaluation of the portal vein before TIPS-PVR, 56 (77%) had involvement of the MPV, LPV, or RPV. SMV involvement was present in 45 patients (62%), while 16 patients (22%) had splenic vein involvement.
 After one year, 43 (90 %) of the patients had patent TIPS, and 36 (75%) maintained portal vein patency. Recurrent PVT was observed in 11 patients (15%). Adverse events included medically managed hepatic encephalopathy in 8 patients (11%), with 7 being successfully managed with medication and 1 case refractory to medical treatment. Additionally, ascites occurred in 2 patients (3%), and variceal bleeding in 1 patient (1%).TIPS revisions were required in 24/73 (33 % ) patients to maintain patency at one year.
The overall mortality rate was 29%, with 15 patients (21%) successfully undergoing liver transplantation. 14 (93 %) of the liver transplant recipients received an end-to-end anastomosis for the portal vein. 1 patient had no information  as they received a liver transplant in Asia.

Conclusion: Portal vein recanalization through TIPS may be an effective and safe procedure for treating PVT in cirrhotic patients, providing high rates of portal vein and TIPS patency. It can serve as a viable bridge to liver transplantation for selected patients.