Exploration of interventional therapy strategy for portal vein occlusion: a case series study

Eur J Gastroenterol Hepatol. 2020 Apr;32(4):507-516. doi: 10.1097/MEG.0000000000001586.

Abstract

Objectives: To explore the candidates, efficacy and safety of interventional therapies in the treatment of portal vein occlusion (PVO).

Methods: In our study, 13 patients diagnosed with PVO were included. Of all 13 patients, two received percutaneous portal vein recanalization (PVR), 10 received PVR and transjugular intrahepatic portosystemic shunt (PVR-TIPS), and one underwent intrahepatic portal branch-large collateral vessel shunt.

Results: Interventional approaches were completed in all patients, and the technical success rate was 100%. The portal pressure gradient of patients treated with PVR-TIPS fell from 31 ± 4 to 12 ± 3 mmHg. During the procedures, no life-threatening complications occurred. All the clinical symptoms were effectively controlled after the interventional therapies and all the patients survived during the follow-up, with no rebleeding or overt hepatic encephalopathy. But stent thrombosis occurred in one patient, the cumulative rate of stent patency was 92%.

Conclusion: Interventional therapy was proved to be a well tolerated and effective strategy for PVO. For PVO patients without high intrahepatic resistance, if the patient is equipped with available portal inflow tract (superior mesenteric vein or splenic vein) and outflow tract (intrahepatic portal branches), PVR is the first choice; if the outflow tract is completely blocked with only available inflow tract, PVR-TIPS can be considered. For PVO patients with high intrahepatic resistance, as long as there is an available portal inflow tract, PVR-TIPS can be adopted.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Angioplasty, Balloon
  • Collateral Circulation
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Selection
  • Portal Pressure
  • Portal Vein* / diagnostic imaging
  • Portal Vein* / physiopathology
  • Portal Vein* / surgery
  • Portasystemic Shunt, Surgical* / instrumentation
  • Portasystemic Shunt, Surgical* / methods
  • Portasystemic Shunt, Transjugular Intrahepatic
  • Prosthesis Implantation
  • Stents
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Venous Insufficiency / complications
  • Venous Insufficiency / diagnostic imaging
  • Venous Insufficiency / physiopathology
  • Venous Insufficiency / therapy*
  • Venous Thrombosis* / complications
  • Venous Thrombosis* / diagnostic imaging
  • Venous Thrombosis* / physiopathology
  • Venous Thrombosis* / therapy
  • Young Adult