2017•Zhonghua gan-dan waike zazhiRequires access
Percutaneous transhepatic intrahepatic portosystemic shunt for treatment of portal hypertension due to chronic portal vein occlusion after splenectomy
Junyang Luo, Mingan Li, Haofan Wang, Chun‐Ying Wu, Zhengran Li, Jiesheng Qian, Shouhai Guan, Mingsheng Huang
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Abstract
Objective
To study the feasibility and efficacy of percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS) in patients with portal hypertension due to chronic portal vein occlusion after splenectomy.
Methods
27 patients who had portal hypertension due to chronic portal vein occlusion after splenectomy underwent PTIPS between December 2010 and March 2015. These patients were enrolled in this retrospective study. The success rates, efficacy, and complications were evaluated. Significance in the differences in the portosystemic pressure gradient (PPG) as measured before and after PTIPS procedure was assessed.
Results
PTIPS was successfully carried out in 25 patients but failed in 2. No fatal procedural complications were observed. The mean PPG dropped from (22.3±5.7) mmHg to (12.4±3.1) mmHg after successful PTIPS (1 mmHg=0.133 kPa, P<0.05). The median follow-up in the 25 patients with successful PTIPS were 22 months and there were 3 (12.0%) deaths from liver failure due to severe cirrhosis, and 1 death (4.0%) from stroke during the follow-up period. Shunt dysfunction happened in 4 (16.0%) patients. The original symptoms reoccurred in 2 patients (8.0%) and the remaining patients were diagnosed by routine CT or US examination. Three patients recovered after shunt revision with stent implantation or balloon angioplasty, while one patient refused any further therapy except oral medication. This patient suffered from the first episode of rebleeding 36 months after PTIPS. Hepatic encephalopathy developed in 2 (8.0%) patients, 1 patient recovered after medical treatment, while the other who developed Grade 3 hepatic encephalopathy recovered after implanting a smaller cover stent. The remaining patients were asymptomatic with patent shunts.
Conclusion
PTIPS was a feasible, safe, and efficacious treatment for portal hypertension due to chronic portal vein occlusion after splenectomy.
Key words:
Venous thrombosis; Portal vein, hypertension; Splenectomy; Portosystemic shunt