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Purpose <p>To investigate whether the presence of baseline portal vein thrombosis (PVT) and its anatomical subtypes influence long-term outcomes in cirrhotic patients with esophagogastric variceal bleeding (EGVB) undergoing technically successful&#xa0;transjugular intrahepatic portosystemic shunt (TIPS).</p> Materials and Methods <p>This retrospective cohort study included 140 cirrhotic EGVB patients who underwent successful TIPS between 2017 and 2024. Patients were stratified into groups with (n = 52) and without baseline PVT (n = 88) based on cross-sectional imaging. PVT was subclassified into simple (main trunk only) and mixed (extending to branches/mesenteric veins) types. The primary composite endpoint included all-cause mortality, variceal rebleeding, or shunt dysfunction. Kaplan–Meier analysis and multivariable Cox regression were performed.</p> Results <p>Median follow-up was 1286&#xa0;days. Composite endpoint events occurred in 59 patients (42.1%), with no significant difference between&#xa0;patients with and without PVT (40.4% vs. 43.2%, P = 0.742). Cumulative event-free survival was comparable (log-rank P = 0.650). Within the PVT cohort, no difference was observed between simple and mixed subtypes (HR = 0.80, P = 0.736). Multivariable analysis confirmed that&#xa0;baseline&#xa0;PVT was not an independent predictor of adverse outcomes (HR = 0.92, P = 0.799). However, higher&#xa0;baseline&#xa0;portal pressure gradient (PPG) (HR = 1.09 per mmHg, P = 0.002) and prior&#xa0;history of&#xa0;overt hepatic encephalopathy (OHE) (HR = 3.33, P = 0.040) were&#xa0;identified as independent predictors.</p> Conclusions <p>Baseline PVT, regardless of morphological subtype, does not appear to adversely affect long-term outcomes&#xa0;in the specific cohort of patients in whom TIPS is technically feasible and successful.&#xa0;Higher baseline PPG and history of OHE are primary determinants of long-term prognosis.</p> Graphical Abstract <p></p>

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Baseline Portal Vein Thrombosis does not Worsen Long-Term Outcomes After Technically Successful TIPS in Cirrhotic Variceal Bleeding: A Single-Center Retrospective Cohort Study

  • 期刊论文

  • 发表日期：

    2026年5月11日

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  • Hongying Gan,
  • Ting Jiang,
  • Jiao Yu,
  • Zhitao Song,
  • Dan Zheng,
  • Fan Wu

摘要

Purpose

To investigate whether the presence of baseline portal vein thrombosis (PVT) and its anatomical subtypes influence long-term outcomes in cirrhotic patients with esophagogastric variceal bleeding (EGVB) undergoing technically successful transjugular intrahepatic portosystemic shunt (TIPS).

Materials and Methods

This retrospective cohort study included 140 cirrhotic EGVB patients who underwent successful TIPS between 2017 and 2024. Patients were stratified into groups with (n = 52) and without baseline PVT (n = 88) based on cross-sectional imaging. PVT was subclassified into simple (main trunk only) and mixed (extending to branches/mesenteric veins) types. The primary composite endpoint included all-cause mortality, variceal rebleeding, or shunt dysfunction. Kaplan–Meier analysis and multivariable Cox regression were performed.

Results

Median follow-up was 1286 days. Composite endpoint events occurred in 59 patients (42.1%), with no significant difference between patients with and without PVT (40.4% vs. 43.2%, P = 0.742). Cumulative event-free survival was comparable (log-rank P = 0.650). Within the PVT cohort, no difference was observed between simple and mixed subtypes (HR = 0.80, P = 0.736). Multivariable analysis confirmed that baseline PVT was not an independent predictor of adverse outcomes (HR = 0.92, P = 0.799). However, higher baseline portal pressure gradient (PPG) (HR = 1.09 per mmHg, P = 0.002) and prior history of overt hepatic encephalopathy (OHE) (HR = 3.33, P = 0.040) were identified as independent predictors.

Conclusions

Baseline PVT, regardless of morphological subtype, does not appear to adversely affect long-term outcomes in the specific cohort of patients in whom TIPS is technically feasible and successful. Higher baseline PPG and history of OHE are primary determinants of long-term prognosis.

Graphical Abstract