Transjugular intrahepatic porto-systemic shunts in the setting of portal vein thrombosis: a review.

Yeoh, Sern Wei; Kok, Hong Kuan

AIM The presence of portal venous thrombosis (PVT) has previously been considered a contraindication to the insertion of transjugular intrahepatic porto-systemic shunts (TIPSS). However, patients with PVT may be symptomatic with complications of portal hypertension, and may thus benefit from TIPSS to reduce portal venous pressure. There is increasing literature discussing the techniques and outcomes of TIPSS in PVT. This review summarises the techniques, indications and outcomes of TIPSS in PVT across published case reports, case series and comparative trials, especially regarding the reduction in portal hypertensive complications such as variceal bleeding. METHODS A comprehensive literature search was conducted using databases MEDLINE and PubMed. Manuscripts published in English between 1st January 1990 and 1st March 2021 were used. Abstracts were screened and data from potentially relevant articles analysed. RESULTS TIPSS in PVT has been reported with high levels of technical success, short-term portal vein recanalisation and long-term PV patency and TIPSS patency outcomes. Several comparative studies, including randomised controlled trials, have shown favourable outcomes compared to non-TIPSS treatment of PVT complications. Outcomes of TIPSS with PVT appear similar to those in TIPSS without PVT. However TIPSS may be more technically difficult in the presence of PVT, and such procedures should be performed in high-volume expert centres to mitigate the risk of procedural complications. CONCLUSIONS The presence of PVT should no longer be considered a contraindication to TIPSS. TIPSS for PVT has been acknowledged as a therapeutic strategy in recent international guidelines, although further studies are needed before recommendations can be strengthened. This article is protected by copyright. All rights reserved.