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Purpose <p>This study assesses the efficacy and safety of Portal Vein Recanalization with Intrahepatic Portosystemic Shunt (PVR-TIPS) in non-cirrhotic patients with chronic portal vein occlusion (CPVO), cavernomatous transformation, and symptomatic portal hypertension (PH) and/or portal vein thrombotic progression.</p> Material and Methods <p>Medical records of 21 non-cirrhotic patients with CPVO and portal cavernoma undergoing PVR-TIPS were analyzed. Hemodynamic (intraprocedural reduction in portosystemic pressure gradient), clinical (data on gastrointestinal bleeding, abdominal pain, ascites, and presence of esophageal varices from imaging exams) and technical success (PVR-TIPS) assessed efficacy. Safety was determined through complications classified according to the <i>CIRSE Classification System</i>.</p> Results <p>PVR-TIPS was successfully performed in all patients, resulting in a significant reduction in portal pressure gradient by 10&#xa0;mmHg (21.475 ± 9.7&#xa0;mmHg – 11.454 ± 5,4&#xa0;mmHg, p &lt; 0.001), alleviating portal hypertension symptoms without thrombotic progression. Clinical success included resolution or reduction of ascites (p = 0.016), gastroesophageal varices (p = 0.004), abdominal pain (p = 0.0021), and cessation of gastrointestinal bleeding (p = 0.021). Complications occurred in 33% of patients, including six grade III events (1 perioperative liver bleeding, 5 delayed stent occlusions) and one grade VI event resulting in death (4.8%). Primary patency rate was 76% (21.3&#xa0;months, range:0.2–82), secondary patency 100% (4&#xa0;months, range:3.8–40.8). Survival at follow-up was 90.4%, with one unrelated death. One patient underwent liver transplantation, three became eligible post-recanalization.</p> Conclusion <p>PVR-TIPS proves effective and safe in reducing portal pressure gradient, thereby alleviating PH symptoms without evidence of portal thrombosis progression in non-cirrhotic patients with CPVO and portal cavernoma. It expands therapeutic options, including liver transplantation.</p> Graphical abstract <p></p>

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Safety and Efficacy of Portal Vein Recanalization with Creation of Intrahepatic Portosystemic Shunt (PVR-TIPS) to Treat Chronic Portal Vein Thrombosis in Non-cirrhotic Patients

  • 期刊论文

  • 发表日期：

    2025年1月9日

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  • F. Barbosa,
  • P. Aseni,
  • M. Vertemati,
  • C. Becchetti,
  • A. Airoldi,
  • A. De Gasperi,
  • P. Gemma,
  • F. Morelli,
  • A. Alfonsi,
  • P. Brambillasca,
  • M. Solcia,
  • C. Andriullo,
  • F. Ferla,
  • M. Nichelatti,
  • G. Perricone,
  • S. De Nicola,
  • L. Belli,
  • A. Rampoldi,
  • F. C. Carnevale

摘要

Purpose

This study assesses the efficacy and safety of Portal Vein Recanalization with Intrahepatic Portosystemic Shunt (PVR-TIPS) in non-cirrhotic patients with chronic portal vein occlusion (CPVO), cavernomatous transformation, and symptomatic portal hypertension (PH) and/or portal vein thrombotic progression.

Material and Methods

Medical records of 21 non-cirrhotic patients with CPVO and portal cavernoma undergoing PVR-TIPS were analyzed. Hemodynamic (intraprocedural reduction in portosystemic pressure gradient), clinical (data on gastrointestinal bleeding, abdominal pain, ascites, and presence of esophageal varices from imaging exams) and technical success (PVR-TIPS) assessed efficacy. Safety was determined through complications classified according to the CIRSE Classification System.

Results

PVR-TIPS was successfully performed in all patients, resulting in a significant reduction in portal pressure gradient by 10 mmHg (21.475 ± 9.7 mmHg – 11.454 ± 5,4 mmHg, p < 0.001), alleviating portal hypertension symptoms without thrombotic progression. Clinical success included resolution or reduction of ascites (p = 0.016), gastroesophageal varices (p = 0.004), abdominal pain (p = 0.0021), and cessation of gastrointestinal bleeding (p = 0.021). Complications occurred in 33% of patients, including six grade III events (1 perioperative liver bleeding, 5 delayed stent occlusions) and one grade VI event resulting in death (4.8%). Primary patency rate was 76% (21.3 months, range:0.2–82), secondary patency 100% (4 months, range:3.8–40.8). Survival at follow-up was 90.4%, with one unrelated death. One patient underwent liver transplantation, three became eligible post-recanalization.

Conclusion

PVR-TIPS proves effective and safe in reducing portal pressure gradient, thereby alleviating PH symptoms without evidence of portal thrombosis progression in non-cirrhotic patients with CPVO and portal cavernoma. It expands therapeutic options, including liver transplantation.

Graphical abstract