1Maryam Boumezrag, 1George Lynskey, 1Saher Sabri

1Medstar Georgetown University Hospital, Washington Dc, United States; 2Medstar Washington Hospital Center, Washington Dc, United States

Background:

Transjugular Intrahepatic Portosystemic Shunt (TIPS) is widely accepted procedure for secondary prevention of variceal bleeding and management of refractory ascites. In patients with concomitant portal vein thrombosis (PVT), non-visualization of the portal vein presents technical difficulty. In such cases, trans-splenic approach can be utilized to assist with PV recanalization prior to TIPS placement. In the subset of patients with cirrhosis who subsequently undergo transplant, obtaining portal vein patency also allows for anatomical end-to-end anastomosis which decreases morbidity and mortality.

Material(s) and Method(s):

A retrospective review of our institutional database from February 2018 and December 2020 was performed. In total, 30 patients (21 males, 9 females; median age, 57.5 years; range 19–73) were indicated for trans-splenic TIPS. All patients had concomitant PVT. 63% (n= 19/30) had cirrhosis with an average MELD of 18.3. The outcome measures included technical success, clinical success and complications.

Result(s):

Technical success was achieved in 27/30 patients (90%). Complications occurred in three of 30 (10%) patients. Mean imaging follow-up period was 162 days (range 1-925 days; median 48 days). During the follow-up period, 14/27 (52%) required a secondary TIPS intervention. Two or more re-interventions were needed in 8/27 (30%) patients. Stent patency at last follow up was 25/27 (93%). None of the patients had variceal bleeding following TIPS. Seven patients underwent transplant after TIPS. Anatomical end-to-end anastomosis was performed in 6/7.

Conclusion(s):

The trans-splenic approach to TIPS is a reliable alternative to traditional TIPS in patients with portal vein thrombosis and provides high technical and clinical success rates.