Single Center Experience of Portal Vein Recanalization and Transjugular Intrahepatic Shunt (PVR-TIPS) Placement in Patients with Portovisceral Thrombosis.

Objective: To report the technical and clinical success rates of portal and visceral vein recanalization with transjugular intrahepatic portosystemic shunt placement (PVR-TIPS) for the management of portovisceral venous thrombosis (PVT), to assess the patency of the main portal vein and TIPS, and to identify predictors of reocclusion and need for reintervention.

Methods: This retrospective study included 43 consecutive patients who underwent PVR-TIPS at a single medical center. 88.4% (38/43) of patients had chronic thrombus and 48.9% (21/43) had Yerdel grade III or IV PVT. Indications for PVR-TIPS included variceal bleeding, refractory ascites, and liver transplant or surgical candidacy for patients with partial or complete occlusion. Evaluated outcomes included technical and clinical success rates, adverse events, main portal vein and TIPS patency, and reintervention rates. Cox proportional hazards regression analysis was used to evaluate potential predictors of reocclusion and need for reintervention.

Results: The technical and clinical success rates were 97.7% and 92.7%, respectively. Seven patients (16.3%) had adverse events. Over a median follow-up of 10.7 months, Kaplan-Meier analysis demonstrated primary patency rates of 86%, 61%, and 46% at 1, 6, and 12 months, respectively. Primary-assisted patency was 94%, 87%, and 74% at 1, 6, and 12 months. Reinterventions were needed in 18 patients (41.9%). No significant predictors of reocclusion or need for reintervention were identified. Eight patients underwent successful liver transplant; 7 received an end-to-end portal vein anastomosis.

Conclusions: PVR-TIPS is safe, technically feasible, and associated with durable clinical improvement with high patency rates in patients with PVT.